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目的 探讨急性高容量血液稀释 (AHH)对颅脑肿瘤手术患者颈内静脉血气和压力的影响 ,评价AHH在颅脑手术中的应用价值。方法 幕上肿瘤择期行开颅手术患者 2 2例 ,麻醉诱导后常规输入乳酸钠林格液的同时输入琥珀酰明胶 (佳乐施 ,15ml/kg ,5 0ml/min)。所有患者均采用地氟醚吸入维持麻醉 ,控制呼吸 ,AHH前后地氟醚的呼出浓度和呼气末二氧化碳分压相等。从颈内静脉逆行置管至颈内静脉球部 ,AHH前后分别于颈内静脉球部采集血样行血气分析 ,连续监测颈内静脉球部压力 (JBP)、平均动脉压 (MAP)和心率。结果 AHH后颈内静脉血氧饱和度 (SO2 )和氧分压 (PO2 )较AHH前明显升高 (P <0 .0 5 ) ,JBP、MAP和心率无明显变化 (P >0 .0 5 )。结论 AHH可改善颅脑手术患者脑氧供需平衡 ,不升高JBP ,可维持充分的脑灌注 ,循环平稳 ,具有临床应用价值
Objective To investigate the effect of acute high volume hemodilution (AHH) on the blood gas and pressure of jugular vein in patients with craniocerebral tumor and to evaluate the value of AHH in craniocerebral surgery. Methods Twenty-two patients undergoing craniotomy under supratentorial tumors were anesthetized with succinyl gelatin (Jiaxishi, 15ml / kg, 50ml / min) while Ringer’s Ringer’s solution was routinely injected. All patients were treated with inhalation of desflurane to maintain anesthesia and control breathing. The desflurane before and after AHH had the same exhaled concentration and end-tidal carbon dioxide partial pressure. Blood samples were collected from the jugular bulb before and after AHH for blood gas analysis, and the jugular bulb pressure (JBP), mean arterial pressure (MAP) and heart rate were continuously monitored from the jugular vein to the jugular bulb. Results The internal oxygen saturation (SO2) and oxygen partial pressure (PO2) of the jugular vein in AHH were significantly higher than those before AHH (P <0.05), but there was no significant change in JBP, MAP and heart rate (P> 0.05) ). Conclusion AHH can improve brain oxygen supply and demand balance in patients with brain surgery, do not increase the JBP, maintain adequate cerebral perfusion, stable circulation, with clinical value