Effects of hypertonic sodium chloride hydroxyethyl starch solution on cerebral vasospasm in patients with ruptured aneurysm undergoing interventional embolization surgery

Abstract

Objective To investigate the protective effect and potential mechanisms of hypertonic sodium chloride hydroxyethyl starch solution(HSH) on cerebral vasospasm (CVS) in patients with ruptured aneurysm undergoing interventional embolization surgery. Methods Thirty aSAH patients with Ⅱ or Ⅲ level of ASA and Hunt/Hess, 1 or 2 grade of improvement Fisher, 13-15 score of GCS, 18-80 years of age and undergoing interventional embolization surgery were randomly divided into 2 groups(n=15): group H and group N. For group H, patients received 4.2% HSH(4 ml/kg). For group N, patients received normal saline (4 ml/kg). Than, the MAP, CVP, plasma osmotic pressure(POP), HR, Na+, K+, Cl- were recorded at 8 AM of different day time points: preoperative induction (T0), the end of intravenous infusion of HSH or normal saline(T1), the end of surgery(T2), 1st day after operation(T3), 2nd day after operation(T4), 3rd day after operation(T5), 4th day after operation(T6), 5th day after operation(T7). Right middle cerebral artery blood flow velocity was monitored with transcranial doppler(TCD) at T3-T7. The plasma IL-6, TNF-α, endothelin-1(ET-1) andnitric oxide(NO) productions were measured by ELlSA, and glasgow coma scale(GCS), china stroke scale(CSS) and 24 h of fluid therapy were recorded at T3-T7. Results Compared with group N, CVP in group H was significantly higher than that in group N at T1-T7(P 0.05). Conclusions Intravenous infusion of HSH could effectively attenuate cerebral vasospasm in patients with aSAH undergoing interventional embolization surgery, which may be through inhibiting inflammation and breaking the imbalance of ET-1 and NO. Key words: Hypertonic sodium chloride hydroxyethyl starch solution; Intracranial aneurysms; Interventional therapy; Vasospasm