23.4%高渗盐水治疗颅内高压的临床研究  

The use of 23.4% hypertonic saline in the treatment of intracranial hypertension.

作　　者：曾红科[1] 叶珩[1] 李辉[1] 陈纯波[1] 吴粤[1] 孙诚[1] 詹国华[1] 

机构地区：[1]广东省人民医院急诊科,广州510080

出　　处：《中华急诊医学杂志》2002年第3期176-178,共3页Chinese Journal of Emergency Medicine

基　　金：广东省医学科学技术研究基金项目 (A19990 0 5 )

摘　　要：目的　探讨 2 3 4 %高渗盐水治疗颅内高压的疗效及副作用。方法　对 2 0名昏迷的、有侧脑室引流指征的脑出血患者进行共 4 6例次降颅内高压试验。静脉推注 2 3 4 %高渗盐水 30ml。用药前至用药后6h内 ,持续监测颅内压 (ICP)、平均动脉压 (MAP)、中心静脉压 (CVP)、脑灌注压 (CPP)、血生化。结果　用药后 (2 8 8± 2 0 7)min ,ICP从 (4 1± 1 5 )kPa降至 (1 6± 0 7)kPa (P <0 0 1) ;其中 39例次的ICP降幅≥ 5 0 %。用药后 (4 5± 1 4 )hICP升到用药前水平。用药后 30min ,MAP降低 (P <0 0 5 ) ,CPP升高 (P <0 0 5 )。CVP、血生化以及渗透压稳定。结论　 2 3 4 %高渗盐水能在不降低CPP的情况下 ,于2 8 8min内使颅内压下降 6 2 % ,持续作用近 4 5h。Objective To determine the effect and the side effects of using 23 4% hypertonic saline on intracranial hypertension.Methods 20 comatose patients,who had cerebral hemorrhage and the indications for the use of lateral ventricular puncture,and a total of 46 episodes of intracranial hypertension with intravenous bolus of 30ml of 23 4% saline.We continuously monitored intracranial pressure(ICP),mean arterial pressure(MAP),central venous pressure(CVP),cerebral perfusion pressure(CPP) and serun electrolytes,from initiation of treatment to 6 hours after.Results ICP was reduced from(4 1±1 5)kPa at initiation of therapy to(1 6±0 7)kPa at(28 8±20 7) minutes after therapy( P <0 01).In 39 episodes of intracranial hypertension,ICP decreased by ≥50% of the pretreatment value.(4 1±1 5)hours later ICP again increased to the level before treatment.MAP decreased at 30minutes flowing treatment( P <0 05),and CPP was improved( P <0 05).There was no significant difference in CVP,serum electrolytes and osmotic pressure before and after treatment.Conclusion Intravenous bolus administration of 23 4% saline can reduce ICP by 62% of the pretreatment value over a duration of 28 8 minutes,without CPP decreasing.This reduction can be maintained for 4 5 hours.[

关 键 词：颅内高压 高渗盐水 脑出血 疗效 副作用 给药方法 

分 类 号：R459.7[医药卫生—急诊医学]