Change in circulating blood volume following craniotomy
Change in circulating blood volume following craniotomy
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DOI：
10.3171/jns.2000.93.4.0581
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发表时间：
2000-10-01
影响因子：
4.1
通讯作者：
Hori, T
中科院分区：
文献类型：
--
作者：
Hirasawa, K;Kasuya, H;Hori, T
Object.在危重患者围手术期管理中监测循环血容量（CBV）的重要性已得到广泛认可。本研究旨在应用吲哚青绿脉冲血流速度计研究开颅术后脑血流速度的变化。循环血容量和与压力和液体调节相关的血浆激素测量了五次：对17例脑肿瘤或未破裂动脉瘤患者在术前、术后即刻、术后1、2、7天进行了CBV检查，术前CBV平均值为82 ml/kg，术后即刻降至64 ml/kg（78%），术后第7天逐渐恢复至82 ml/kg（p = 0.0069）。术后即刻肾上腺素、去甲肾上腺素、精氨酸加压素、肾素和醛固酮的平均值最高。平均术中水和钠平衡分别为1090 ml和113 mEq。在整个研究期间，CBV与去甲肾上腺素和血清钠的偏相关系数分别为-0.430（p = 0.0036）和0.418（p = 0.0048）。应注意开颅手术后CBV降低，这是由于手术应激导致液体转移到间质间隙所致。术后血钠减少可怀疑血容量减少。
Object. The importance of monitoring circulating blood volume (CBV) during perioperative management is widely recognized in critically ill patients. The purpose of this study was to investigate the change in CBV following craniotomy by using indocyanine-green pulse spectrophotometry.Methods. Circulating blood volume and plasma hormones related to stress and fluid regulation were measured five times: preoperatively, immediately postoperatively, and 1, 2, and 7 days after craniotomy was performed in 17 patients with a brain tumor or an unruptured aneurysm.The mean value of CBV preoperatively was 82 ml/kg, which decreased to 64 ml/kg (78%) immediately postoperatively and gradually recovered to 82 ml/kg on Day 7 postsurgery (p = 0.0069). The mean values of adrenaline, noradrenaline, arginine vasopressin, renin, and aldosterone were highest immediately postoperatively. The mean intraoperative balances of water and sodium were 1090 ml and 113 mEq, respectively. Partial correlation coefficients of CBV to noradrenaline and serum sodium during the entire study were -0.430 (p = 0.0036) and 0.418 (p = 0.0048), respectively.Conclusions. Attention should be paid to decreased CBV following craniotomy, which is caused by the shift of fluid to interstitial spaces due to surgical stress. Hypovolemia can be suspected from a postoperative decrease in serum sodium.