颅内动脉瘤夹闭术的“3H”疗法

aneser

颅内动脉瘤开颅夹闭后是否常规行“3H”疗法？标准是什么？欢迎探讨一下。

sumsczc

一、Triple-H therapy 存争议，是否使用，请与神经外科医生充分沟通后，共做决定。

二、实施triple-H therapy标准，摘录Handbook of Neuroanesthesia（ 4th Edition）的guidelines，仅供参考。

(1)  Central venous pressure (CVP) of 10 mm Hg
       Pulmonary capillary wedge pressure (PCWP) of 12 to 16 mm Hg
       The vagal and diuretic response to intravascular volume augmentation may necessitate the administration of atropine, 1 mg intramuscularly (i.m.) every 3 to 4 hours.
       Aqeous vasopressin (Pitressin), 5 units i.m., to reduce urine output to <200 mL/hour.
       Hydrocortisone has also been used to attenuate the excessive natriuresis and consequent hyponatremia seen in patients after SAH and to prevent the decrease in total blood volume.
      The use of albumin to augment intravascular volume after the administration of normal saline has failed to increase the CVP above 8 mm Hg may improve clinical outcome at 3 months and reduce hospital costs.
(2)  Vasopressor drugs, including dopamine, dobutamine, and phenylephrine, may be necessary to increase blood pressure. If the aneurysm has not been secured, systolic pressure is maintained at 120 to 150 mm Hg. After the aneurysm has been secured, systolic blood pressure may be increased to 160 to 200 mm Hg. Invasive hemodynamic monitoring including the direct measurement of systemic arterial blood pressure, CVP, pulmonary artery pressure, PCWP, and cardiac output improves the safety and efficacy of treatment with induced hypertension.
（3）Relative hemodilution to a hematocrit of 30% to 35% promotes blood flow through the cerebral microvasculature.
—— Handbook of Neuroanesthesia（ 4th Edition）P155

三、我院去年100多例开颅动脉瘤手术，术中夹闭动脉瘤后多未行triple-H therapy，而术后均予施行。个中原因，揣摸不得。

ft7918

不是很清楚，能详细说明一下吗