高渗盐水治疗创伤性脑水肿合并颅内高压的疗效分析  

Hypertonic saline for the treatment of intracranial hypertension due to traumatic brain edema

作　　者：颜玉峰[1] 姚慧斌[1] 沈晓[1] 季耀东[2] 

机构地区：[1]复旦大学附属金山医院,上海201508 [2]复旦大学附属华山医院,上海200040

出　　处：《创伤外科杂志》2013年第4期296-300,共5页Journal of Traumatic Surgery

摘　　要：目的比较3.0%、7.5%高渗盐水(HS)和20%甘露醇治疗创伤性脑水肿合并颅内高压的疗效。方法 16例重度颅脑损伤(TBI)患者随机分为2组,第1组接受3.0%HS和20%甘露醇治疗,第2组接受7.5%HS和20%甘露醇治疗,两组随机接受HS和甘露醇降颅压治疗各至少2次,用药后6h内连续监测颅内压(ICP)、平均动脉压(MAP)、血钠浓度及尿量的变化。采用非参数的Wilcoxon秩和检验进行统计学分析。结果应用3.0%、7.5%HS和甘露醇治疗后,颅内压均明显下降(P<0.05),三种药物使用前后ICP无差异(P>0.05),但3.0%和7.5%HS持续时间较甘露醇长(P<0.05),其中3.0%HS作用持续时间较7.5%HS更持久(P<0.05)。结论快速静注3.0%HS能显著降低ICP及提高MAP,且无明显不良反应,是一种安全有效治疗创伤性颅高压的药物。Objective To analyze the clinical efficacy of 3. 0% and 7. 5% hypertonic saline（ HS） with 20% mannitol in treating intracranial hypertension due to traumatic brain edema. Methods Sixteen patients with severe traumatic brain injury were divided into two groups. Group 1 received 3. 0% HS and 20% mannitol separately,and group 2 received 7. 5% HS and 20% mannitol separately. Patients in the two groups were treated with HS and mannitol for at least two times. Intracranial pressure （ ICP） ,mean arterial pressure （ MAP） ,serum sodium and urine volume were monitored continuously within 6 hours after the initiation of therapy. The non-parametric Wilcoxon signed-rank test was used to analyze the data. Results Treatment with 3. 0% ,7. 5% HS and mannitol significantly reduced intracranial pressure（ P 0. 05） . There was no difference in reducing intracranial pressure among them（ P 0. 05） . 3. 0% HS had a longer effective duration than 7. 5% HS and mannitol （ P 0. 05） . Conclusion The bolus infusions of HS could rapidly decrease the ICP and increase the MAP without obvious side-effect in patients with traumatic brain edema. 3. 0% HS has been proved to be a safe and effective therapy for intracranial hypertension after traumatic brain edema.

关 键 词：颅脑损伤 脑水肿 高渗盐水 颅内压 

分 类 号：R651.15[医药卫生—外科学]