连续应用10%高渗盐水治疗外伤性颅高压的临床观察  

Clinical analysis of continuous infusion of 10% hypertonic saline in the treatment of traumatic intracranial hypertension

作　　者：龙瑞芬[1] 许小林[1] 陈益璠[1] 谢淑芳[1] 秦恒义[1] 许志杰[1] 胡青[1] 李华贞[1] 

机构地区：[1]郴州市第一人民医院ICU二区,湖南郴州423000

出　　处：《海南医学》2011年第22期9-11,共3页Hainan Medical Journal

摘　　要：目的观察10%高渗盐水(HS)对脑外伤后颅高压的治疗效果与安全性,并与甘露醇进行比较。方法选择我院2010年1月至2011年3月外伤性颅高压患者64例,均行颅内压监测,随机分为甘露醇组(20%甘露醇125ml/次,34例)及高渗盐水组[(10%高渗盐水1.3ml/(kg·次),30例)]进行脱水,均间隔8h一次,观察两组患者颅内压(ICP)、平均动脉压(MAP)、血钠、血浆渗透压、肾功能、药物起效及持续时间及药物副作用。结果二者起效时间、降颅压幅度及对MAP的影响差异无统计学意义,高渗盐水作用持续时间更长,能使CVP轻度升高,二组比较差异具有统计学意义(P<0.05)。但随着应用时间延长(>48h),降颅压幅度下降,且有出现高血钠的风险。结论 HS能有效降低颅内压,但连续应用超过48h有出现高血钠的风险。Objective To observe the therapeutic effects and safety of 10% hypertonic saline solution in the treatment of traumatic intracranial hypertension. Methods Sixty-four patients with severe brain injury admitted in our hospital from Jan. 2010 to Mar. 2011 were randomly divided to two groups： Group HS （n=34） and group M （n=30）. Patients in group HS were infused with 1.3 ml/kg of 10% hypertonic saline every 8 hours, and those in group M received 125 ml of 20% mannitol every 8 hours. The intracranial pressure （ICP）, mean artery pressure （MAP）, center vein pressure （CVP）, serum sodium, osmotic pressure, renal function, the onset time and lasting duration, as well as the side effects were compared between the two groups. Results The two groups showed no statistically significant difference in the onset time, ICP, and MAP. The lasting duration in group HS was significantly longer, resulting in slight increase in CVP. Along with the continuous infusion of hypertonic saline over 48 hours, the ICP decreased significantly, and the serum sodium was increased. Conclusion Hypertonic saline can effectively decrease ICP caused by severe brain injury, but continuous infusion of it （over 48 hours） could result in increased serum sodium level.

关 键 词：高渗盐水 甘露醇 颅脑损伤 颅内压 

分 类 号：R651.1[医药卫生—外科学]