摘要
目的探讨控制性降压(CH)联合氨甲环酸(TA)对脑肿瘤手术患者血流动力学、动脉血气及血电解质的影响。方法选择择期全麻脑肿瘤手术患者40例,随机分为A、B组各20例。两组均在切开脑膜行颅内操作时采用硝普钠行CH,0.1%硝普钠4~5μg/(kg·min)持续微泵输注,控制平均动脉压(MAP)为60 mm Hg,关闭脑膜后终止CH。A组在CH基础上应用TA,切开皮肤前给予TA 10 mg/kg静脉注射,之后TA 1 mg/(kg·h)持续静脉滴注至手术结束。分别于麻醉前(T_1)、麻醉后降压前(T_2)、降压后30 min(T_3)、停止降压30 min(T_4)、术毕(T_5),用多参数监护仪监测MAP、中心静脉压(CVP)、心率(HR)、血氧饱和度(SPO2);用罗氏Cobas b123血气分析仪检测血红蛋白(Hb)、红细胞压积(HCT)、血小板(PLT)及动脉血气[p H、动脉氧分压(PaO_2)、动脉血氧分压(PaCO_2)、碱剩余(BE)]、血电解质(K^+、Na^+、Cl-、Ca^(2+))。结果两组各时间点CVP、HR、SPO_2组间、组内比较差异无统计学意义(P均>0.05);两组组内T_2、T_3、T_4MAP与T_1比较均降低(P均<0.05),两组间各时间点MAP比较差异无统计学意义(P均>0.05)。两组间和组内PLT比较差异无统计学意义(P均>0.05);两组Hb、HCT在T_2、T_3、T_4、T_5时与T_1比较均降低(P均<0.05),在T5时A组Hb、HCT大于B组(P均<0.05)。两组组间、组内各时间点动脉血气指标、血电解质比较差异无统计学意义(P均>0.05)。结论 CH联合TA对脑肿瘤手术患者血流动力学、动脉血气及血电解质影响不大,且有一定的血液保护作用。
Objective To investigate the effects of controlled hypotension（ CH） combined with tranexamic acid（ TA）on hemodynamics,blood gas and electrolytes of patients after brain tumor surgery. Methods Forty patients with brain tumor under general anesthesia were randomly divided into group A and group B with 20 patients in each group. Group A was given CH combined with TA,while group B was given CH. During CH,0. 1% sodium nitroprusside at 4-5 mu g /（ kg / min） was continuously infused,and the mean arterial pressure（ MAP） was 60 mm Hg. In the group A,TA was used before skin incision,10 mg / kg intravenous injection was conducted,then 1 mg /（ kg·h） TA of continuous intravenous drip was applied until the end of surgery. MAP,CVP,HR,SPO2,Hb,HCT,PLT,blood gas and plasma electrolytes were respectively recorded at the following points： before anesthesia（ T1）,immediate before surgery（ T2）,30 min after the start of CH（ T3）,30 min after stopping CH（ T4） and at the end of operation（ T5）. Results There were no significant differences in CVP,HR and SPO2 between these two groups at different time（ all P〈0. 05）. MAP at T2,T3,T4 was decreased as compared with that at T1 in the two groups（ all P〈0. 05）,but there were no significant differences in MAP between these two groups at different time（ all P〈0. 05）. No significant differences were found in PLT between these two groups（ all P〉0. 05）. Hb and HCT at T2,T3,T4 was decreased as compared with that at T1 in the two groups（ all P〈0. 05）,and Hb and HCT of group A was higher than that of group B at T5（ all P〈0. 05）. Meanwhile,there were no significant differences in the blood gas and electrolytes between these two groups（ all P〉0. 05）. Conclusion CH combined with TA has little effect on hemodynamics,blood gas and electrolyte and it has some blood protective effect in patients after brain tumor surgery.
作者
骆喜宝
王菲
刘志贵
覃祥玲
黄志华
朱玉民
翟庶文
LUO Xibao WANG Fei LIU Zhigui QIN Xiangling HUANG Zhihua ZHU Yuming ZHAI Shuwen(The Second Affiliated Hospital of Guilin Medical Universit)
出处
《山东医药》
CAS
北大核心
2016年第37期15-17,共3页
Shandong Medical Journal
基金
广西高校科学技术研究项目(KY2015LX253)
广西壮族自治区卫生厅计划课题(Z2014300)
关键词
脑肿瘤
控制性降压
氨甲环酸
血液保护
血流动力学
brain neoplasms
controlled hypotension
tranexamic acid
blood conservation
hemodynamics
