Bhatnagar Neelesh, Bhateja Saurabh, Jeenger Lalita, Mangal Govind, Gupta Sunanda
Department of Anesthesiology and Critical Care, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India.
J Anaesthesiol Clin Pharmacol. 2021 Oct-Dec;37(4):523-528. doi: 10.4103/joacp.JOACP_169_18. Epub 2022 Jan 6.
The current study was designed to compare the effects of two different doses of 3% hypertonic saline with mannitol on intraoperative events during decompressive craniectomy in traumatic brain injury (TBI). Primary outcome measures included assessment of intraoperative brain relaxation, hemodynamic variables, and serum electrolytes. Effect on the postoperative outcome, in terms of the Glasgow coma scale (GCS), length of stay in the ICU, and mortality were the secondary outcome measures.
Ninety patients with TBI undergoing craniotomy were enrolled. Patients were assigned to receive 300 mL (328 mOsm) of mannitol ( = 26, M) only or 300 mL of mannitol with 150 mL (482 mOsm) of 3% HS ( = 35, HS) or with 300 mL (636 mOsm) of 3% HS ( = 29, HS). Brain relaxation was assessed and if required, a rescue dose of mannitol (150 mL) was given. GCS was assessed preoperatively, 24 h postoperatively, and at the time of discharge from the ICU and total duration of stay was noted.
Acceptable brain relaxation was observed in 89.66% ( = 26, HS) and 80% ( = 28, HS) patients as compared to 46.1% ( = 12, M) patients ( < 0.001) with significantly less number of patients requiring rescue doses of mannitol in groups HS and HS( = 7 and 3, respectively) as compared to group M ( = 14) ( < 0.05). There was a significant improvement in GCS at 24 h and at the time of discharge from the ICU in patients with a severe head injury in group HS ( = 0.029). In patients with moderate head injury there was a significant improvement in GCS at the time of discharge among all the three groups ( < 0.05).
Increasing osmotic load by addition of 3% HS to mannitol provides better intraoperative brain relaxation than mannitol alone during decompressive craniectomy. An addition of 300mL 3% HS was found to be more effective in improving GCS in patients with severe TBI.
本研究旨在比较两种不同剂量的3%高渗盐水与甘露醇对创伤性脑损伤（TBI）减压性颅骨切除术术中情况的影响。主要观察指标包括术中脑松弛度、血流动力学变量和血清电解质评估。次要观察指标为对术后结果的影响，以格拉斯哥昏迷量表（GCS）、重症监护病房（ICU）住院时间和死亡率来衡量。
纳入90例行开颅手术的TBI患者。患者被分配接受仅300 mL（328 mOsm）甘露醇（n = 26，M组），或300 mL甘露醇加150 mL（482 mOsm）3%高渗盐水（n = 35，HS1组），或300 mL甘露醇加300 mL（636 mOsm）3%高渗盐水（n = 29，HS2组）。评估脑松弛度，如有需要，给予150 mL甘露醇的抢救剂量。术前、术后24小时、从ICU出院时评估GCS，并记录总住院时间。
与46.1%（n = 12，M组）的患者相比，89.66%（n = 26，HS2组）和80%（n = 28，HS1组）的患者观察到可接受的脑松弛度（P < 0.001），与M组（n = 14）相比，HS1组和HS2组需要甘露醇抢救剂量的患者数量显著减少（分别为n = 7和n = 3）（P < 0.05）。HS2组重度颅脑损伤患者术后24小时及从ICU出院时GCS有显著改善（P = 0.029）。在中度颅脑损伤患者中，三组患者出院时GCS均有显著改善（P < 0.05）。
在减压性颅骨切除术中，甘露醇添加3%高渗盐水增加渗透压负荷比单独使用甘露醇能提供更好的术中脑松弛度。发现添加300 mL 3%高渗盐水对改善重度TBI患者的GCS更有效。
