【原】【罂粟摘要】20%甘露醇、3%高渗盐水和8.4%碳酸氢钠对幕上肿瘤开颅手术患者术中脑松弛和血流动力学参数的评价：前瞻性随机研究

20%甘露醇、3%高渗盐水和8.4%碳酸氢钠对幕上肿瘤开颅手术患者术中脑松弛和血流动力学参数的评价：前瞻性随机研究

贵州医科大学  麻醉与心脏电生理课题组

翻译：李奕    编辑：柏雪   审校：曹莹

背景：比较20%甘露醇、3%高渗盐水和8.4%碳酸氢钠用于幕上肿瘤切除术中高渗治疗的研究很少。假设等渗浓度的这些药物将产生相同的效果，本研究旨在比较其对术中脑松弛和血流动力学的影响。

方法：这项前瞻性研究进行了一年多。将90例年龄18-60岁、ASAΙ和ΙΙ级的幕上肿瘤患者随机分为三组，分别接受等渗的20%甘露醇(第1组)、3%高渗盐水(第2组)和8.4%碳酸氢钠(第3组)。评估的主要结果是术中脑松弛评分的影响，血液动力学参数、动脉血气参数变化、血电解质、血浆渗透压、尿量、液体摄入、术后病程、住院时间是次要结果。

结果：三组间的人口统计学特征、手术和麻醉变量具有可比性。与第2组和第1组相比，第3组的大脑松弛评分明显更好。与其他组相比，第1组患者的平均血压和中心静脉压值较低，尿量和液体摄入量较高。与第1组和第2组相比，第3组患者的pH值、碳酸氢盐、二氧化碳分压、血清钠和血浆渗透压值显著升高。

结论：与3%高渗盐水溶液和20%甘露醇相比，输注8.4%碳酸氢钠溶液与较高的术中脑松弛评分和改善的血流动力学稳定性相关。

原始文献来源：Amiya K Barik , Sanjay Agrawal , Priyanka Gupta, et al. Evaluation of equiosmolar 20% mannitol, 3% hypertonic saline and 8.4% sodium bicarbonate on intraoperative brain relaxation and hemodynamic parameters in patients undergoing craniotomy for supratentorial tumors: a prospective randomized study.[J].Minerva Anestesiol. 2021 Sep;87(9):997-1005.

英文原文：

Evaluation of equiosmolar 20% mannitol, 3% hypertonic saline and 8.4% sodium bicarbonate on intraoperative brain relaxation and hemodynamic parameters in patients undergoing craniotomy for supratentorial tumors: a prospective randomized study

Abstract

Background: Research comparing 20% mannitol, 3% hypertonic saline and 8.4% sodium bicarbonate for intraoperative hyperosmolar therapy during supratentorial tumor excision is sparse. With the hypothesis that equiosmolar concentration of these agents will produce equivalent effects, this study was conducted to compare the effects on intraoperative brain relaxation and hemodynamics.

Method:The prospective study was conducted over a period of one year. Ninety patients, aged 18-60 years, American Society of Anesthesiologists class Ι and ΙΙ with supratentorial tumor and scheduled for surgery were randomized into three groups to receive equiosmolar 20% mannitol (group 1), 3% hypertonic saline (group 2) and 8.4% sodium bicarbonate (group 3). Primary outcome assessed was the effect on intraoperative brain relaxation score while hemodynamic parameters, changes in arterial blood gas parameters, serum electrolytes, serum osmolarity, urine output, fluid intake, post-operative course, hospital stay were the secondary outcomes.

Results:Demographic characteristics, surgical and anesthetic variables, were comparable between the three groups. Brain relaxation scores were significantly better in group 3 compared to group 2 and group 1 respectively. Patients in group 1 had lower mean blood pressure and central venous pressure values, higher urine output, fluid intake compared to other groups. Patients of group 3 had significantly higher pH, bicarbonate, partial pressure of carbon dioxide, serum sodium and serum osmolarity values compared to groups 1 and 2.

Conclusion:Eight point four percent sodium bicarbonate solution infusion is associated with superior intraoperative brain relaxation scores and improved haemodynamic stability compared to equiosmolar 3% hypertonic saline solution and 20% mannitol.

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