不同浓度高渗盐水对颅脑创伤后颅内高压患者的疗效观察  

Clinical curative effect observation of different concentrations of hypertonic saline in patients with intracranial hypertension after traumatic brain injury

作　　者：杨细平[1] 张馨予[2] 涂悦[1] 商崇智[1] 王飞[3] 张赛[1] YANG Xi-ping;ZHANG Xin-yu;TU Yue;SHANG Chong-zhi;WANG Fei;ZHANG Sai(Department of Neurosurgery, the Affiliated Hospital of Logistics University of Chinese People’s Armed Police Forces, Tianjin 300162, China;Institute of Biochemistry and Molecular Biology, Logistics University of Chinese People’s Armed Police Forces;Department of Cardiology, the Affiliated Hospital of Logistics University of Chinese People’s Armed Police Forces)

机构地区：[1]武警后勤学院附属医院神经外科 [2]武警后勤学院临床医学系生物化学与分子生物学教研室 [3]武警后勤学院附属医院心内科

出　　处：《天津医药》2017年第8期810-814,共5页Tianjin Medical Journal

基　　金：武警后勤学院科学研究基金资助项目(WHJ2015021);天津市心血管重塑与靶器官损伤重点实验室开放基金项目(TJC1405)

摘　　要：目的观察不同浓度的高渗盐水(HS)及20%甘露醇对中重型颅脑创伤患者的降颅压效果。方法采用随机数字表法将60例中重型颅脑创伤患者分为7.5%HS组、3%HS组及20%甘露醇组,每组患者各20例。3组均按照颅脑创伤诊疗规范接受常规治疗,当颅内压(ICP)超过20 mmHg且持续时间达到5 min以上时,给予相应的高渗脱水治疗。连续监测3组患者治疗前及治疗后6 h内ICP、平均动脉压(MAP)、脑灌注压(CPP)、每小时尿量、血钠浓度情况。结果 7.5%HS组、3%HS组及20%甘露醇均能降低ICP(P<0.05),但7.5%HS的起效时间、ICP降低幅度及有效降压时间均好于3%HS及20%甘露醇组(P<0.05);7.5%HS及3%HS均能升高MAP及CPP,对血钠浓度无明显影响,但其利尿作用弱于20%甘露醇。结论快速静脉滴注7.5%HS能显著降低中重型颅脑创伤患者的ICP,提高MAP,增加CPP,且无明显并发症,是一种安全有效的治疗创伤后颅内高压的药物。Objective To study the effects of different concentrations of hypertonic saline(HS)and20%mannitol ondecreasing intracranial pressure(ICP)in patients with moderate-sever traumatic brain injury(TBI).Methods A total of60patients were randomly assigned into7.5%HS group,3%HS group and20%mannitol group,20patients in each group.Allof patients were treated with conventional treatment according to the diagnostic and treatment practices of TBI.When ICPwas above20mmHg for more than5minutes,patients were administered corresponding hypertonic dehydrator.The levels ofICP,mean arterial pressure(MAP),cerebral perfusion pressure(CPP),urine volume per hour and serum sodium weremonitored continuously within6hours after the initiation of therapy.Results All agents could significantly decrease theICP(P<0.05),but the onset time in7.5%HS group was less than that of the other two groups(P<0.05),and the decreasedmagnitude of ICP and the effective time of decreasing ICP in7.5%HS group were more than those of the other two groups(P<0.05).Both7.5%HS and3%HS could increase MAP and CPP.There was no statistical difference in serum sodiumbetween both groups,but the diuretic effect in both groups was worse than that of20%mannitol group.Conclusion Therapidly infusion of7.5%HS could significantly decrease the ICP,increase the MAP and CPP without obvious side-effect inpatients with moderate-sever TBI,and which is a safe and effective therapy for intracranial hypertension after traumaticbrain injury.

关 键 词：颅脑损伤 盐水 高渗 甘露醇 颅内压 利尿 平均动脉压 脑灌注压 

分 类 号：R651.15[医药卫生—外科学]