不同浓度高渗盐水对颅脑损伤患者颅高压的影响  

Correlation between different concentrations of hypertonic saline and 20% mannitol in the treatment of craniocerebral injury in patients with craniocerebral injury and its prognosis

作　　者：叶嘉辉 丁燕晶[1] YE Jia-hui(Department of Critical Care Medicine,Houjie Hospital of Dongguan, Dongguan 523900,China)

机构地区：[1]东莞市厚街医院重症医学科

出　　处：《牡丹江医学院学报》2019年第4期23-26,11,共5页Journal of Mudanjiang Medical University

基　　金：东莞市医疗卫生科技计划项目(2018507150231378)

摘　　要：目的探讨不同浓度高渗盐水对颅脑损伤患者的颅高压治疗效果及其预后的影响。方法选取2018年3月至2019年2月间入住我院重症医学科的颅脑损伤患者60例,随机分为A、B、C三组(各20例)。A组:3%的高渗盐水150mL静脉注射,每6h1次,0.5mL/kg·h;B组:10%的高渗盐水0.8mL/kg静脉注射,每6h1次,200mL/h;C组:20%甘露醇0.5g/kg静脉滴注,比较三组患者治疗前、治疗后0.5、1、2、3、6h颅内压(intracranial pressure,ICP)、平均动脉压(mean arterial pressure,MAP)、脑灌注压(cerebral perfusion pressure,CPP)水平变化,比较治疗前、治疗后6h血钠、血浆渗透压,降颅压显效时间、持续时间以及患者预后情况。结果治疗前三组患者ICP、MAP、CPP均无显著性差异( P> 0.05),治疗后三组患者ICP均得到有效控制,A组患者治疗后3h ICP开始上升,而B、C组患者治疗后2h后ICP开始上升,差异具有统计学意义( P <0.05)。治疗后3h内三组患者MAP、CPP均显著上升,且A、B组患者上升幅度更显著,差异具有统计学意义( P< 0.05)。而治疗后6h,三组患者MAP、CPP与治疗前无统计学差异( P> 0.05),治疗前、治疗后6h三组患者血钠、血浆渗透压差异无统计学差异( P> 0.05),C组患者降颅压显效时间显著延长,A组患者降颅压持续时间显著延长,差异具有统计学意义( P< 0.05),A、B组患者预后优于C组,差异具有统计学意义( P< 0.05),而A、B组患者预后无显著性差异( P> 0.05),三组患者不良反应发生率差异无统计学意义(χ^2=5.536, P= 0.765)。结论高渗盐水、甘露醇治疗重型颅脑损伤患者能够有效降低患者的颅内压,在降压效果和持续时间方面,3%高渗盐水的作用更显著,治疗过程中要严格控制药物的输注速度、密切实时监测血钠、血浆渗透的改变,减少不良反应的发生,建议在临床上推广。Objective To investigate the effect of different concentrations of hypertonic saline and 20% mannitol on intracranial hypertension and prognosis in patients with craniocerebral injury. Methods Sixty patients with craniocerebral injury who were admitted to the Department of Critical Care Medicine from March 2018 to February 2019 were randomly divided into three groups: A, B, and C (20 cases each). Group A: 3% high Infiltration of saline 150mL Intravenous injection, once every 6 hours 0.5mL/kg·h;Group B: 10% hypertonic saline 0.8mL/kg Intravenous injection, once every 6 hours 200mL/h;Group C: 20% mannitol 0.5g/kg intravenous injection. The intracranial pressure (ICP), mean arterial pressure (MAP), and cerebral perfusion pressure(CPP) at 0.5、1、2、3、6 h before and after treatment were compared among the three Group. The blood sodium, plasma osmotic pressure, reduction of intracranial pressure effective time and duration, prognosis at 6h before and after treatment were also compared. Results There were no significant differences in ICP, MAP, and CPP among the three groups before treatment ( P>0.05 ). After treatment,the ICP were effectively controlled in the three groups. The ICP in group A began to increase at 3h after treatment, while the ICP of patients in group B and C began to increase at 2h after treatment. The difference had statistically significant ( P<0.05 ). The MAP and CPP of the three groups increased significantly within 3 hours after treatment,and the increase was more significant in the A and B groups, the difference was statistically significant ( P<0.05 ). There was no significant difference in MAP and CPP between the three groups after treatment ( P> 0.05 ). There was no significant difference in blood sodium and plasma osmotic pressure between the three groups before treatment and 6 hours after treatment ( P>0.05 ). The effective time of intracranial pressure was significantly prolonged in the group. The duration of intracranial pressure was significantly prolonged in group A ( P<0.05 ). Th

关 键 词：高渗盐水 甘露醇 颅脑损伤 颅内高压 预后 

分 类 号：R651.1[医药卫生—外科学]