高渗盐水抢救颅脑损伤所致急性颅内高压的临床研究  

Clinical research about the curative effect of hypertonic saline on acute intracranial hypertension caused by craniocerebral injury

作　　者：刘万宝[1] 刘剑[1] 乔着意[1] 赵庆波[1] 王梅[1] 

机构地区：[1]解放军第324医院急诊科,重庆400020

出　　处：《中国急救医学》2011年第9期777-780,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨高渗盐水（hypertonicsaline，HS）在急诊科抢救颅脑损伤所致急性颅内高压患者首次降颅压治疗中的临床疗效。方法颅脑损伤所致急性颅内高压患者60例，随机分为3％HS组（20例）、10％HS组（20例）和20％甘露醇（mannitol，MT）组（20例）。3％HS组静脉给予3％HS260mL，10％HS组静脉给予10％HS80mL，MT组静脉给予20％MT250mL，并于用药前及用药后30、60、90rain和2、3、4、5h监测颅内压（intraeranialpressure，ICP）、平均动脉压（meanarterypressure，MAP），记录尿量，观察生命体征变化，监测血生化指标。结果①HS组于用药后30minICP达到最大降幅，显著早于MT组（P〈0．05），3％HS的降ICP作用可维持至少4h，优于其余两组（P〈0．05）。②3％HS和10％HS用药后MAP较用药前显著升高（P〈0．05），且3％HS升压作用持续时间较10％HS延长（P〈0．05）；而20％MT用药后MAP较用药前无显著变化（P〉0．05）。③静脉快速滴注3％HS、10％HS和20％MT后脑灌注压（CPP）均显著升高（P〈0．05）；三组CPP升幅比较差异无统计学意义（P〉0．05），但3％HS作用持续时间较10％HS、20％MT显著延长（P〈0．05）。结论①与MT比较，HS抢救颅脑损伤所致急性颅内高压起效更快、更持久，维持ICP更平稳。②两种浓度HS都能显著升高MAP，具有显著扩容作用。③三组均能升高CPP，以3％HS持续时间较长。Objective To investigate the curative effect of hypertonic saline （HS） on the patients with acute intracranial hypertension caused by craniocerebral injury in emergency department. Methods Patients with acute intracranial hypertension caused by craniocerebral injury were divided into three groups including 3% HS group, 10% HS group and 20% mannitol （MT） group randomly. The intracranial pressure（ICP）, mean arterial pressure （MAP）, blood pressure（BP）, cerebral perfusion pressure（ CPP）, urine output and blood biochemical parameters were recorded before the treatment and at 30, 60, 90 min and 2, 3, 4, 5 h after 3% HS 260 mL, 10% HS 80 mL and 20% MT250 mL treatment respectively. Results （1）The ICP decreased greatly at 30 min after HS treatment, which was earlier than in MT group（P 〈0.05）. Moreover, decreased ICP of 3% HS group maintained for 4 h, which was better than other groups（P 〈 0.05）. （2）The MAP increased after treatment in HS group, and the duration was longer in 3% HS group than in 10% HS group（P 〈0.05）. However, the MAP in MT group had no significant difference compared with control （ P 〉 0. 05 ）. （3）The CPP increased sharply after treatment of 3% HS, 10% HS and 20% MT, and there was no significant difference in the increased amplitude among three groups（ P 〉 0.05 ） , but the duration was longer in 3% HS group than in other groups （ P 〈 0.05 ）. Conclusion HS plays important role in rescuing patients with acute intracranial hypertension, and has fast effects, long duration and more steady ICP compared with MT group. Moreover, both 3% HS and 10% HS can increase MAP and are effective in fluid expansion.CPP is increased greatly after treatment of all three fluids, but the duration of 3% HS is the longest.

关 键 词：高渗盐水 颅内高压 甘露醇 颅脑损伤 

分 类 号：R651.15[医药卫生—外科学]