Abstract：
Background: A prospective, randomized, double-blind study was designed to assess differences in brain relaxation between 2 doses of 3% HS during elective supratentorial brain tumour surgery.Methods: 60 patients undergoing supratentorial craniotomy for tumour resection were enrolled to receive either 3 mL/kg (group L) or 5 mL/kg (group H) of 3% HS administered at skin incision. Brain relaxation was assessed after dura opening on a scale ranging 1-4 (1 = perfectly relaxed, 2 = satisfactorily relaxed, 3 = firm brain, 4 = bulging brain). Hemodynamic variables and laboratory values (blood gases, osmolarity, haematocrit, and lactate) were collected before HS infusion and 30, 120 and 360 min after it. Presence of midline shift, postoperative complications, PCU and hospital stay, and mortality after 30 days were also recorded.Results: There was no difference in brain relaxation, with 2.0 (1.0-3.0) and 2.0 (1.0-2.3) (P = 0.535) for patients in groups L and H, respectively. If adjusted for the presence of midline shift, 50% of patients had adequate brain relaxation scores (grades 1 and 2) in group L and 61% in group H (OR 0.64, CI = 0.16-2.49, P = 0.515). No significant differences in perioperative outcome, mortality and length of PCU and hospital stay were observed.Conclusion: 3 mL/kg of 3% HS result in similar brain relaxation scores as 5 mL/kg in patients undergoing craniotomy for supratentorial brain tumour. This study reveals that both high and low doses of 3% HS may be less effective on intraoperative brain relaxation in patients with midline shift.
摘要：
背景：一个前瞻性的，随机化，双盲研究旨在评估选择性幕上脑肿瘤手术期间2种剂量的3%HS之间的脑松弛差异.方法：60例接受幕上开颅手术切除肿瘤的患者，在皮肤切口处接受3mL/kg（L组）或5mL/kg（H组）的3％HS。在硬膜开放后，以1-4的量表评估大脑松弛（1=完全放松，2=令人满意地放松，3=坚固的大脑，4=大脑膨胀）。血液动力学变量和实验室值(血气，渗透压,血细胞比容,和乳酸）在HS输注之前和之后30、120和360分钟收集。存在中线移位，术后并发症,PCU和住院时间，并记录30天后的死亡率。结果：大脑松弛没有差异，L组和H组患者分别为2.0（1.0-3.0）和2.0（1.0-2.3）（P=0.535），分别。如果针对中线移位的存在进行调整，L组有50％的患者有足够的脑松弛评分（1级和2级），H组有61％（OR0.64，CI=0.16-2.49，P=0.515）。围手术期结局无显著差异，观察PCU的死亡率和长度以及住院时间.结论：3mL/kg的3％HS在进行幕上脑肿瘤开颅手术的患者中产生的脑松弛评分与5mL/kg相似。这项研究表明，高剂量和低剂量的3％HS可能对中线移位患者的术中脑松弛效果较差。
