PDF(Pubmed)
Abstract：
BACKGROUND: Mannitol is widely used in neurosurgical units to mitigate raised intracranial pressure and cerebral edema, crucial in postoperative management. Its hyperosmolar properties reduce brain extracellular fluid, thereby altering cerebral perfusion and cardiac dynamics. However, the temporal and combined effects of mannitol on cardiovascular and cerebrovascular parameters remain inadequately explored in postoperative settings.
METHODS: This prospective observational study enrolled 20 adult patients who underwent elective craniotomies for tumor excision. Mannitol was administered to the patients at a dose of 0.5 mg/kg/dose as a bolus dose over 20 to 30 minutes. The time interval was eight hours between the doses (scheduled dosing). Patients received their first dose of mannitol in the ICU after eight hours of intraoperative dose. The patients were given mannitol for two postoperative days and followed up for two days in the postoperative period. Transthoracic echocardiography and transcranial color Doppler were used to assess cardiovascular and cerebrovascular parameters at multiple intervals post-mannitol administration.
RESULTS: Significant increases in mean flow velocities were observed bilaterally immediately post-mannitol administration on the first postoperative day, indicative of improved cerebral blood flow. However, these changes were transient, with no significant variations noted on the second postoperative day. Cerebrovascular resistance, as measured by the pulsatility index, showed non-significant changes bilaterally across both days. Cardiovascular parameters, including stroke volume and cardiac output, remained stable throughout the study period.
CONCLUSIONS: Mannitol administration at 0.5 g/kg in postoperative neurosurgical patients transiently improves cerebral perfusion without causing significant hemodynamic instability. This study underscores the importance of monitoring both cerebrovascular and cardiovascular parameters post-mannitol administration to optimize patient management and outcomes.
METHODS: This prospective observational study enrolled 20 adult patients who underwent elective craniotomies for tumor excision. Mannitol was administered to the patients at a dose of 0.5 mg/kg/dose as a bolus dose over 20 to 30 minutes. The time interval was eight hours between the doses (scheduled dosing). Patients received their first dose of mannitol in the ICU after eight hours of intraoperative dose. The patients were given mannitol for two postoperative days and followed up for two days in the postoperative period. Transthoracic echocardiography and transcranial color Doppler were used to assess cardiovascular and cerebrovascular parameters at multiple intervals post-mannitol administration.
RESULTS: Significant increases in mean flow velocities were observed bilaterally immediately post-mannitol administration on the first postoperative day, indicative of improved cerebral blood flow. However, these changes were transient, with no significant variations noted on the second postoperative day. Cerebrovascular resistance, as measured by the pulsatility index, showed non-significant changes bilaterally across both days. Cardiovascular parameters, including stroke volume and cardiac output, remained stable throughout the study period.
CONCLUSIONS: Mannitol administration at 0.5 g/kg in postoperative neurosurgical patients transiently improves cerebral perfusion without causing significant hemodynamic instability. This study underscores the importance of monitoring both cerebrovascular and cardiovascular parameters post-mannitol administration to optimize patient management and outcomes.
摘要：
背景：甘露醇广泛用于神经外科，以减轻颅内压升高和脑水肿，在术后管理中至关重要。它的高渗性能减少脑细胞外液，从而改变脑灌注和心脏动力学。然而,在术后设置中,甘露醇对心血管和脑血管参数的时间效应和联合效应仍未得到充分研究.
方法：这项前瞻性观察性研究纳入了20名接受选择性开颅手术切除肿瘤的成年患者。将甘露醇以0.5mg/kg/剂量的剂量作为推注剂量在20至30分钟内给予患者。剂量之间的时间间隔为8小时(预定给药)。术中8小时后，患者在ICU接受了首次剂量的甘露醇。患者术后给予甘露醇2天,术后随访2天。经胸超声心动图和经颅彩色多普勒用于评估甘露醇给药后多个间隔的心血管和脑血管参数。
结果：在术后第一天给予甘露醇后立即观察到双侧平均流速显著增加，表明脑血流量改善。然而,这些变化是短暂的，在术后第二天没有明显变化。脑血管阻力，用搏动指数衡量，在这两天的双边表现出不显著的变化。心血管参数,包括每搏输出量和心输出量,在整个研究期间保持稳定。
结论：神经外科术后患者给予0.5g/kg甘露醇可短暂改善脑灌注，而不会引起明显的血流动力学不稳定。这项研究强调了甘露醇给药后监测脑血管和心血管参数以优化患者管理和结果的重要性。
方法：这项前瞻性观察性研究纳入了20名接受选择性开颅手术切除肿瘤的成年患者。将甘露醇以0.5mg/kg/剂量的剂量作为推注剂量在20至30分钟内给予患者。剂量之间的时间间隔为8小时(预定给药)。术中8小时后，患者在ICU接受了首次剂量的甘露醇。患者术后给予甘露醇2天,术后随访2天。经胸超声心动图和经颅彩色多普勒用于评估甘露醇给药后多个间隔的心血管和脑血管参数。
结果：在术后第一天给予甘露醇后立即观察到双侧平均流速显著增加，表明脑血流量改善。然而,这些变化是短暂的，在术后第二天没有明显变化。脑血管阻力，用搏动指数衡量，在这两天的双边表现出不显著的变化。心血管参数,包括每搏输出量和心输出量,在整个研究期间保持稳定。
结论：神经外科术后患者给予0.5g/kg甘露醇可短暂改善脑灌注，而不会引起明显的血流动力学不稳定。这项研究强调了甘露醇给药后监测脑血管和心血管参数以优化患者管理和结果的重要性。
