芒硝外敷治疗颅脑外伤术后脑水肿的临床研究  

The clinical study of external application of mirabilite to treat the postoperative brain edema in brain injury patients

作　　者：张珏[1] 许乐宜[1] 龚立[1] 书国伟[1] 王静予[1] 蔡佩浩[1] 邱锋[1] 孔令军[1] 费智敏[1] 谭晓辉[1] 于淼[1] 陈莉芳[1] 

机构地区：[1]上海中医药大学附属曙光医院神经外科,201203

出　　处：《国际中医中药杂志》2015年第9期785-787,共3页International Journal of Traditional Chinese Medicine

基　　金：上海市教委预算内项目（2012JW41）;上海市市级医院适宜技术（SHDCl2012227）

摘　　要：目的 评价芒硝外敷治疗颅脑外伤去骨瓣减压术后脑水肿的临床疗效.方法 将符合纳入标准的颅脑外伤去骨瓣减压术后患者60例,按随机数字表法分为2组各30例,2组均在颅内压监测基础上行阶梯化治疗,常规治疗组在伤口处以消毒棉垫覆盖减压窗,芒硝外敷组以一次性芒硝敷料袋覆盖减压窗.观察患者术后1周每日颅内压（intracranial pressure, ICP）均值及脑电双频指数（bispectral index, BIS）均值,记录患者住院时间、费用,评价临床疗效.结果 芒硝外敷组ICP均值在术后第2天[（32±2.2）mmHg比（35±2.2）mmHg,t=2.351]、第 3 天[（31±2.0）mmHg 比（33±2.1）mmHg,t=2.224]、第 5 天[（26± 2.3）mmHg 比（28±1.9）mmHg,t=2.536]均低于常规治疗组（P〈0.05）;BIS均值在术后第3天[（47±4.3）比（43±4.2）,t=2.379]、第5天[（55±5.3）比（52±3.9）,t=2.559]均高于常规治疗组（P〈0.05）.平均住院时间,芒硝外敷组为（16.5±1.2）d、常规治疗组为（17.2±1.1）d,2组比较差异有统计学意义（t=2.355,P=0.022）.平均住院费用,芒硝外敷组为（7.37±0.68）万元、常规治疗组为（8.14±1.12）万元,2组比较差异有统计学意义（t=2.056,P=0.042）.结论 芒硝外敷可有效缓解颅脑外伤去骨瓣减压术后的脑水肿.Objective To study the effects of external application of mirabilite in the treatment of brain injury patients with brain edema postoperative of decompressive craniectomy.Methods 60 brain injury patients from the department of neurosurgery in shuguang hospital,who were underwent decompressive craniectomy, were randomly divided into a control group and an observation group, with 30 patients in each.. The observation group was treated according to the results of intracranial pressure （ICP） monitoring. The control group was underwent additional external application of mirabilite. Comparisons were conducted on daily ICP, bispectral index（BIS） and Glasgow coma scale （GCS） in postoperative one week. The hospitalization days and expense were also be analysed. All patients were treated for 3 months and the Glasgow outcome scale （GOS） was recorded. Result The ICP of control group was lower than the observational group in postoperative day 2,3 and 5 （32±2.2 mmHgvs. 35± 2.2 mmHg,t=2.351; 31±2.0 mmHgvs. 33±2.1 mmHg,t=2.224; 26±2.3 mmHgvs. 28±1.9 mmHg, t=2.536）, the BIS is higher in day 3 and 5（47±4.3 vs.43±4.2 t=2.379; 55±5.3 vs.52±3.9, t=2.559）. There was significant difference in hospitalization days between the two groups （16.5 ± 1.2 dvs. 17.2 ± 1.1 d, t=2.355,P=0.022）. There was significant difference between the two groups（P〈0.05）. There was also significant difference in hospitalization expense with 7.37 ± 0.68（million yuan） in the control group and 8.14 ±1.12 in the observational group（t=2.056,P=0.042）.Conclusion The external application of mirabilite was effective in the treatment of brain injury patient with brain edema postoperative of decompressive craniectomy.

关 键 词：颅脑损伤 脑水肿 手术后并发症 芒硝 外治法 

分 类 号：R244.9[医药卫生—针灸推拿学]