20％甘露醇与3％高渗盐水对血浆渗透压和电介质影响的比较

[摘要] 目的 比较3%高渗盐水（HTS）和20%甘露醇（M）对择期颅脑手术病人血浆渗透压和电介质的影响。方法 择期行大脑半球胶质瘤切除术病人40例，男23例，女17例，ASAⅠ或Ⅱ级，随机分为两组，HTS组和M组（n＝20），两组均行静吸复合麻醉，异氟醚呼气末浓度达1MAC后，在15min内输注等渗透剂量3%HTS (5.33ml/kg)或20%甘露醇(1g/kg )。在输注前即刻（T0）、输注后即刻、输注后5, 15, 30, 60, 90, 120 min（T1～T7）检测并记录平均动脉压（MAP）、心率（HR），同时采取5ml左侧桡动脉血测定血球压积、血浆Na+、 K+、Cl-、PH、血浆渗透压。结果 两组各时点MAP和HR变化无统计学意义；与T0比较，两组血浆渗透压在T1～T7升高（P<0.05），在T1达高峰( HTS组: 305mOsm /kg ；M组:304  mOsm/kg)， HTS组T1～T7血浆Na+ 和Cl-浓度升高，（P<0.05），血浆Na+在T1达高峰(152 mEq/kg), M组T1～T7血浆Na+浓度降低（P<0.05），在T1达低谷（130mEq/kg）；两组T1～T7血浆K+浓度降低（P<0.05），但均在正常范围内。结论 在择期神经外科手术中使用5.49mOsm/kg的3％HTS 和20％甘露醇均引起血浆渗透浓度的上升，并在输注结输束达最高值；3％HTS引起血Na+和血Cl－上升，20％甘露醇引起血Na+下降。

关键词] 盐水，等渗；甘露醇；血浆渗透浓度；电介质

[Abstract] Objectives NaCl 3% (HTS) and mannitol 20% (M) are hypertonic solutions used in-patient in hypovolaemic shock and in case of increased ICP. To our knowledge no study in humans compared them in an equiosmolar load. The objectives of this study were to compare the pharmacokinetics of both solutions in an equiosmolar load in terms of osmolarity and electrolytes over time.Methods Fourty ASA I and II patients undergoing selected neurosurgery under general anesthesia were involved.Tow groups were studied (groups HTS and M), each receiving an equiosmolar load (5.49 mOsm kg-1 ) of solutions of saline 3% or mannitol 20% over 15 minutes. Vital parameters (invasive blood pressure, heart rate) were monitored and blood samples (hematocrit,Na + ,Cl–，PH，osmolarity) were assessed preoperatively and at times 0, 5, 15, 30, 60, 90, 120 min after perfusion.Results In both hypertonic groups, osmolarity was maximal at the end of