急重症颅脑外伤颅内压监测与脱水剂合理使用的临床研究  

Clinical study of intracranial pressure monitoring and dehydrant in traumatic brain injury

作　　者：邹胜伟[1] 刘科[1] 黄涛[1] 袁鹏[1] 

机构地区：[1]重庆市急救医疗中心,重庆市第四人民医院神经外科,重庆400014

出　　处：《创伤外科杂志》2011年第1期5-8,共4页Journal of Traumatic Surgery

基　　金：重庆市科委科技攻关项目(CSTC2008AA0011);重庆市卫生局医疗特色专科支助项目(201052)

摘　　要：目的持续动态监测急重症颅脑外伤的颅内压变化,探讨有效降低颅内压的脱水剂合理使用。方法通过持续动态监测56例中重型颅脑外伤的颅内压变化,分析其特点;并选择其中31例颅内压≥30mmHg,以自身对照方式比较两种脱水剂组合(三联组合:甘露醇+甘油果糖+呋塞米;二联组合:甘露醇+呋塞米)的降颅压效果。结果 56例颅内压在15～79mmHg,使用脱水剂后颅内压波动幅度为3～30mmHg。其中31例使用不同组合的脱水剂,使用三联脱水剂组合降颅内压效果明显优于使用二联脱水剂组合降颅内压效果。结论颅脑外伤后颅内压常常呈现出不规则波动,三联脱水剂组合降颅内压效果优于二联组合。Objective To monitor the changes of intracranial pressure（ICP） in traumatic brain injury（TBI） and to explore the application of dehydrant for reducing ICP effectively.Methods Changes of ICP in 56 cases of severe TBI were monitored continuously.Thirty one cases whose ICP were more than or equal to 30mmHg were chosen from those 56 cases.Self-controlled studies were applied in these 31 cases and the effect of dehydrant of different combinations in reducing ICP was compared.The combinations were divided into two ways： manicol ＋ glycerol fructose ＋ furosemide group and manicol ＋ furosemide group.Results The ICP of 56 cases ranged from 15mmHg to 79mmHg with fluctuating range of 3mmHg to 30mmHg after using dehydrant.There was significant difference（P〈0.01） in 31 cases with different combinations.Conclusion ICP of TBI fluctuates irregularly.For dehydrant,the effect of combination of mannitol＋ glycerol fructose ＋ furosemide is better than the combination of mannitol ＋ furosemide.

关 键 词：颅脑损伤 颅内压 甘露醇 甘油果糖 呋塞米 

分 类 号：R651.15[医药卫生—外科学] R453[医药卫生—临床医学]