高渗盐水在重型颅脑损伤去骨瓣减压术后颅内高压治疗中的应用研究  

Hypertonic saline in treatment of intracranial hypertension caused by severe cerebral trauma after decompressive craniectomy

作　　者：秦德广 黄文勇[1] 杨灵[1] 黄传平[2] 梁英强[1] 罗彦斌[1] 黄淑芬[1] 朱上泉 

机构地区：[1]中山市黄圃人民医院神经外科,528429 [2]解放军第四二一医院神经外科,广州510318

出　　处：《中华神经医学杂志》2016年第12期1267-1273,共7页Chinese Journal of Neuromedicine

基　　金：广东省中山市科技计划项目（20122A090）

摘　　要：目的探讨3％高渗盐水（HS）治疗重型颅脑创伤去骨瓣减压术后颅内高压的效果及安全性。方法中山市黄圃人民医院神经外科自2011年1月至2015年5月收治重型颅脑损伤去骨瓣减压术后仍有颅内高压的患者48例，在持续颅内压（ICP）监测下，分别静脉给予3％HS（n=24）和20％甘露醇（MT）治疗（n=24），观察2组患者治疗前和治疗后0．5、1、2、3、4、5、6hICP、平均动脉压（MAP）、中心静脉压（CVP）的变化，治疗前和治疗后1、3、5、7d血清钾、钠、尿素氮、肌酐数值的变化，以及术后并发症、伤后6个月格拉斯哥预后评分的变化。结果HS组、MT组患者治疗后ICP迅速下降，但3％HS起效更为迅速，治疗后0．5h即可使ICP显著下降，且维持时间更长，达近5h，而20％MT疗效维持3h；HS组患者治疗后MAP呈进行性增高，特别是用药后2-4h，MT组患者则无明显变化；治疗后HS组血钠很快上升，血浆渗透压升高，并维持在一个较高水平，MT组则进行性下降；MT组血清肌酐、尿素氮呈进行性升高，特别用药后7d明显上升，而HS组无明显变化；与MT组比较，HS组治疗后0．5、1、2、3、4、5、6hMAP较高，治疗后1、3、5、7d血钠和渗透压较高，治疗后3、5、7d尿素氮、肌酐较低，差异有统计学意义（P〈0．05）。伤后6个月HS组患者预后好于MT组，差异有统计学意义（P＜0．05）。结论3％HS治疗重型颅脑创伤去骨瓣减压术后颅内高压比20％MT更安全有效，可有效减少术后并发症并改善患者预后。Objective To evaluate the effect and safety of 3% hypertonic saline （HS） in intracranial hypertension of patients with severe cerebral trauma after decompressive craniectomy. Methods Forty-eight intracranial hypertension patients suffered from severe cerebral trauma after decompressive craniectomy in our hospital from January 2014 to May 2015 were divided randomly into 3% HS treatment group and 20% mannitol （MT） treatment group （n=24）. Indicators such as intracranial pressure （ICP）, mean arterial pressure （MAP） and central venous pressure were observed before and 0.5, 1, 2, 3, 4, 5 and 6 h after treatment in these two groups; serum electrolyte levels （potassium, sodium, urea nitrogen and creatinine） were measured before and 1, 3, 5 and 7 d after treatment. The postoperative complications and Glasgow Outcome Scale （GOS） scores 6 months after injury were observed. Results ICP levels in both groups after treatment were quickly decreased as compared with those before treatment, with significant difference （P〈0.05）; HS treatment group had more quickly decreased ICP： 0.5 h after treatment, the ICP level was decreased obviously, and HS treatment could be sustained for longer times （almost 5 h） than MT treatment （3 h）. HS treatment group had progressively increased MAP levels,especially 2-4 h after treatment; however, MT treatment group had no such obvious changes; MAP at the same time point between the two groups had significant difference （P〈0.05）. The level of serum sodium was raised quickly and sustained at a high level after continuous administration of HS, while the opposite trend was noted after administration of MT; significant difference was noted between the two groups at the same time point （P〈0.05）. Urea nitrogen and creatinine levels in MT treatment group were obviously increased, especially 7 d after treatment, as compared with those in the HS treatment group （P〈0.05）. The HS treatment group had lower incidence of postoperative complications and

关 键 词：高渗盐水 甘露醇 重型颅脑创伤 去骨瓣减压术 颅内压 

分 类 号：R651.15[医药卫生—外科学]