3%高渗盐水对脑出血患者血肿周围脑水肿及神经功能的影响  

Effect of 3% hypertonic saline on perihematoma brain edema and neurological function in patients with intracerebral hemorrhage

作　　者：廖洪民[1] 王勇[1] 黄建军[1] 匡涛[1] 朱家伟[1] LIAO Hong-min;WANG Yong;HUANG Jian-jun(Department of Neurosurgery,Guizhou aerospace hospital,Zunyi 563003,China)

机构地区：[1]贵州航天医院神经外科,贵州遵义563003

出　　处：《吉林医学》2022年第5期1185-1188,共4页Jilin Medical Journal

基　　金：遵义市科技计划项目[项目编号:遵市科合HZ字(2019)215号]。

摘　　要：目的:探讨3%高渗盐水(HS)对脑出血患者血肿周围脑水肿及早期神经功能的影响。方法:将40例非手术治疗的高血压脑出血患者随机分为观察组和对照组,每组各20例,除常规内科治疗外,观察组静脉滴注3%HS 4 ml/kg,对照组静脉滴注20%甘露醇0.5 g/kg治疗脑水肿,给药频率均为每8小时一次,疗程5 d。观察两组用药前后血糖、肾功能、电解质及血浆渗透压变化情况,比较两组用药后3 d、7 d血肿周围脑水肿体积及治疗后14 d、治疗后30 d的美国国立卫生院卒中量表(NIHSS)评分。结果:用药后3 d两组血钠、血氯、血浆渗透压、尿素氮、肌酐水平比较,差异有统计学意义(P<0.05);观察组用药后3 d、7 d血肿周围脑水肿体积均小于对照组,差异有统计学意义(P<0.05);观察组14 d、30 d NIHSS评分低于对照组,但差异无统计学意义(P>0.05)。结论:3%HS减轻血肿周围脑水肿的作用优于20%甘露醇,且更有利于稳定血钠浓度和血浆渗透压,但未能明显改善患者早期神经功能。Objective To investigate the effect of 3% hypertonic saline on perihematoma brain edema and early neurological function in patients with intracerebral hemorrhage.Method 40 cases with hypertensive cerebral hemorrhage treated by medical treatment were randomly divided into an observation group and a control group, 20 cases in each group. In addition to general medical treatment, the observation group was given intravenous drip of 3% hypertonic saline 4 ml/kg, and the control group was given intravenous drip of 20% mannitol 0.5 g/kg to reduce brain edema. The frequency of medication was once every 8 h for 5 days.The changes of blood glucose, renal function, electrolyte and plasma osmotic pressure were observed before and after treatment in the two groups. The volume of brain edema around hematoma was compared between the two groups on 3 d and 7 d after treatment, and NIHSS scores on 14 d and 30 d were compared.Results There were significant differences in blood sodium, blood chlorine, plasma osmotic pressure, urea nitrogen and creatinine between the two groups 3 days after treatment(P<0.05);The volume of brain edema around hematoma in the observation group was smaller than that in the control group on 3 d and 7 d after treatment, and the difference was statistically significant(P<0.05). The NIHSS of the observation group on 14 d and 30 d was lower than that in the control group, but the difference was not statistically significant(P>0.05).Conclusion The effect of 3% hypertonic saline on reducing perihematoma brain edema was better than that of 20% mannitol, and it is more conducive to stabilizing blood sodium concentration and plasma osmotic pressure, but it can not significantly improve the early neurological function of patients.

关 键 词：脑出血 脑水肿 高渗盐水 甘露醇 血浆渗透压 

分 类 号：R743.34[医药卫生—神经病学与精神病学]