3%和10%高渗盐水治疗外伤性脑水肿合并颅内高压的临床对比分析  

Comparative study of 3% and 10% hypertonic saline in the treatment of brain edema complicated by intracranial hypertension in traumatic brain injury

作　　者：冯东侠[1] 毛霄鹏[2] 叶富华[1] 陈罡[1] 

机构地区：[1]东南大学微侵袭神经外科研究所,江苏江阴214400 [2]东南大学临床医学院,江苏南京210009

出　　处：《中国微侵袭神经外科杂志》2007年第8期337-339,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的为比较3%和10%高渗盐水(HS)治疗外伤性脑水肿合并颅高压的临床疗效。方法12例重型颅脑外伤病人开颅减压术后均接受3%和10%HS降颅压治疗各2次,治疗顺序随机决定。用药后6 h内观察颅内压(ICP)、平均动脉压(MAP)、脑灌注压(CPP)及血钠浓度和血浆渗透压的变化。采用非参数的Wilcoxon秩和检验进行统计学分析。结果应用3%和10%HS后,ICP均下降(P<0.05);且两种药物使用前后ICP的差异无统计学意义(P>0.05)。3%HS作用持续时间较10%HS长(P<0.05)。结论对于外伤性脑水肿所致的ICP升高,快速静注3%及10%HS均能显著降低ICP、提高CPP。3%HS持续时间更长,可作为降低ICP的一线治疗药物。Objective To compare the clinical efficacy of 3% hypertonic saline （HS） with 10% HS in reduction of intracranial hypertension due to traumatic brain edema. Methods Twelve severe head-injured patients firstly underwent decompressive procedure and then each received treatments of 3% HS and 10% HS separately in a random order. Intmcranial pressure （ICP）, mean arterial pressure （MAP）, cerebral perfusion pressure （CPP）, serum sodium and osmotic pressure of plasma were monitored continuously in a 6-hour period after the initiation of treatment. The nonparametric Wilcoxon signed-rank test was used to analyze the data. Results The treatment significantly reduced intmcranial pressure with both 3% and 10% HS （P〈0.05）. There was no difference in reducing intmcranial pressure between the 3% HS and 10% HS （P〉0.05）. 3% HS had a longer effective duration than 10% HS （P〈0.05）. Conclusion The bolus infusions of 3% and 10% HS could rapidly decrease the ICP while increase the CPP in patients with traumatic brain edema. However, 3% HS had a longer duration of effect in reducing ICP. Consequently, 3% HS can be considered the first-line therapeutics for intracranial hypertension after traumatic brain edema.

关 键 词：盐水 高渗 颅内压 脑水肿 颅脑损伤 

分 类 号：R651.15[医药卫生—外科学]