大剂量甘露醇联合甲强龙在严重脑挫裂伤脑疝患者围手术期的应用  

Perioperative Application of Large Dose of Mannitol and Methylprednisolone for Severe Cerebral Contusion and Laceration Combined with Brain Hernia Patients

作　　者：邱平华[1] 黄正华[1] 林孟强 黄翰[1] 王育胜[1] 黄谷[1] 李汉城[1] 

机构地区：[1]广东省揭阳市人民医院神经外科一区,522000 [2]揭东人民医院神经外科

出　　处：《中华全科医学》2013年第8期1229-1230,共2页Chinese Journal of General Practice

摘　　要：目的探讨严重脑挫裂伤脑疝患者行开颅大骨瓣减压围手术期应用大剂量甘露醇联合甲强龙控制颅内压的疗效。方法对严重脑挫裂伤脑疝患者,就诊时即予20%甘露醇250～375 ml快速静脉滴注后再应用生理盐水100ml+甲强龙500 mg静脉滴注,接着再次应用20%甘露醇250 ml快速静脉滴注。第1,2次甘露醇均于2～3 h内用完,部分患者第2次可在术中去除骨瓣硬膜切开前半小时应用。随机选择35例同病种病例,围手术期单独应用20%甘露醇250 ml快速静脉滴注,并进行对比分析。结果经应用该方法后35例患者中,除1例高龄患者出现恶性脑肿胀压力无法控制后,其他病例术中脑压均控制良好,创造良好手术时机,促进手术顺利进行;术后常规脱水补液,维持有效循环量,监测肾功能变化,未出现急性肾功能衰竭病例;效果明显优于对照组(P﹤0.01),差异具统计学意义。结论大剂量(8～10 ml/kg,平均8.9 ml/kg)甘露醇联合甲强龙在严重脑挫裂伤脑疝患者围手术期应用,能有效控制颅高压,创造手术时机,效果好,未出现急性肾功能衰竭现象。Objective To explore the therapeutic efficacy of perioperative large dose of mannitol and methylprednisolone on the control of intracranial pressure in severe cerebral contusion and laceration combined with brain hernia patients undergoing a large decompressive craniotomy（large bone flaps）.Methods Thirty five patients with severe cerebral contusion and laceration combined brain hernia early received 20% mannitol 250-375 ml fast IV drip,followed by normal saline 100 ml ＋ methylprednisolone 500 mg IV drip immediately,again 20% mannitol 250 ml fast IV drip（observation group）.The first two application of mannitol was finished in 2 to 3 hours.The second IV drip of mannitol was perioperative used half an hour before the dural incision.Another 35 cases receiving 20% mannitol 250 ml fast IV drip were selected as control（control gorup）.The therapeutic efficacy was compared between the two groups.Results In the observation group,the intracranial pressure was out of control only in 1 old patient due to malignant brain swelling,other cases got a well perioperative control in the intracranial pressure and prepared a good condition for the surgery.The routine perioperative fluid supplementation was performed to maintain effective circulation.The monitoring for kidney function did not find an acute renal failure case.The effect in the observation group was obviously superior to the control group,and the difference was significant.（P〈0.01）.Conclusion The perioperative large dose of mannitol and methylprednisolone for severe cerebral contusion and laceration merger brain hernia patients can effectively control the cranial pressure,create the timing of surgery,and avoid the occurrence of acute renal failure.

关 键 词：严重脑挫裂伤并脑疝 颅内压 大剂量甘露醇 围手术期 激素 

分 类 号：R651.152[医药卫生—外科学] R977.1[医药卫生—临床医学]