脱水药治疗儿童创伤性颅高压的临床疗效  

Clinical effect of dehydrant agents in the treatment of traumatic cranial hypertension in children

作　　者：李宁[1] 蒋飞[1] 杨威 李禹 LI Ning;JIANG Fei;YANG Wei;LI Yu(Department of Critical Care Medicine,Dalian Children’s Hospital,Liaoning Dalian 116012,China)

机构地区：[1]辽宁省大连市儿童医院重症医学科,辽宁大连116012

出　　处：《临床药物治疗杂志》2021年第12期82-86,共5页Clinical Medication Journal

摘　　要：目的比较20%甘露醇、3%氯化钠注射液、甘油果糖治疗颅高压的临床效果。方法纳入大连市儿童医院2017年4月至2020年5月收治的创伤性颅高压(ICH)患儿,随机分为A、B两组,A组使用20%甘露醇降颅压治疗;B组使用3%氯化钠注射液降颅压治疗。A组在治疗24 h后再随机分为A1、A2两组,A1组继续使用20%甘露醇降颅压治疗;A2组改用甘油果糖降颅内压治疗。比较患儿用药后不同时间颅内压(ICP)、平均动脉压(MAP)、脑灌注压(CPP)的变化及住院时间、呼吸机使用时间和预后。结果A、B两组各自组内及两组间ICP、MAP、CPP用药后30 min、1、2、4 h的ICP、MAP、CPP比较,差异均有统计学意义(P<0.05);A组ICP下降幅度更大且复升速度快,B组MAP、CPP升高维持时间长。A1、A2两组各自组内及两组间用药后不同时间ICP、MAP、CPP比较,差异均有统计学意义(P<0.05);两组ICP均下降,A2组MAP、CPP升高缓慢,但维持时间长。A、B两组患儿住院时间、呼吸机使用时间及出院后3个月预后情况随访,经统计学分析没有统计学意义(P>0.05)。结论在急性颅高压时,选择3%氯化钠注射液降颅压效果优于20%甘露醇。在急性颅高压后期,20%甘露醇和甘油果糖交替使用比甘露醇单独使用可以获得更好的降颅压效果,并有利于维持CPP。Objective To compare the clinical effect of 20%Mannitol,3%Sodium Chloride Injection and Glycerin Fructose in the treatment of cranial hypertension.Methods Children with intracranical hypertension(ICH)treated in Dalian Children’s Hospital from April 2017 to May 2020 were randomly divided into group A and group B.Group A was treated with 20%Mannitol to reduce intracranial pressure(ICP);Group B was treated with 3%Sodium Chloride to reduce ICP.Group A was randomly divided into group A1 and group A2 after 24 hours of treatment.Group A1 continued to use 20%Mannitol to reduce intracranial pressure;Group A2 was treated with Glycerol Fructose to reduce ICP.The changes of ICP,mean arterial pressure(MAP),cerebral perfusion pressure(CPP),hospital stay,ventilator use time and prognosis were compared.Results There were significant differences in ICP,MAP and CPP within and between groups A and B(P<0.05),the decrease of ICP in Group A was significantly and the increase of ICP was rapidly,while map and CPP increased for a long time in group B.The ICP,MAP and CPP of A1 and A2 groups were significantly different at different time after administration(P<0.05).The ICP decreased in both groups,MAP and CPP increased slowly in group A2,but maintained for a long time.The hospital stay,ventilator use time and prognosis of children in group A and B were followed up 3 months after discharge.There was no statistical significance after statistical analysis(P>0.05).Conclusion In acute severe intracranial hypertension,3%Sodium Chloride Injection is more effective than 20%Mannitol in reducing ICP in acute severe intracranial hypertension.In the late stage of acute intracranial hypertension,alternating 20%Mannitol and Glycerol Fructose maybe better than using mannitol alone in reducing ICP and maintaining CPP.

关 键 词：创伤性颅高压 脱水药 儿童 

分 类 号：R977.7[医药卫生—药品]