甘露醇对重型颅脑损伤病人脑脊液渗透压的影响  

Effect of Mannitol on Cerebrospinal Fluid Osmolarity in Patients With Severe Craniocerebral Injury

作　　者：李方成[1] 戴学元[2] 林吉惠[1] 钟志光[1] 谭平国[1] 

机构地区：[1]中山大学附属第二医院神经外科,广州510210 [2]湖北黄石市中心医院神经外科

出　　处：《华南国防医学杂志》2004年第2期1-3,共3页Military Medical Journal of South China

摘　　要：目的:探讨重型颅脑损伤病人在使用甘露醇过程中,脑脊液渗透压的变化规律及其临床意义。方法:根据使用甘露醇时间的长短,将20例重型颅脑损伤病人分为长时程组和短时程组,分别检测使用甘露醇前后不同时间点血浆和脑脊液渗透压值。结果:开始使用甘露醇时,血浆渗透压迅速上升,48h即从(300.7±3.3)mOsm/kg H2O上升至(323.1±5.2)mOsm/kg H2O,然后维持相对稳定;而脑脊液渗透压起初维持稳定,大部分病人24h后开始缓慢上升。甘露醇停用或减量后,血浆渗透压下降迅速而脑脊液渗透压仅轻微下降;使得血浆与脑脊液间的渗透压梯度急剧减小,甚至形成负向渗透压梯度。结论:使用甘露醇过程中血浆-脑脊液渗透压梯度的改变与甘露醇的治疗效果及停用甘露醇出现的“反跳现象”密切相关。Objective To explore the clinical significance and the regular rule of cerebrospinal fluid osmolarity change during using mannitol in patients with severe craniocerebral injury. Method According to the time of using mannitol,20 cases with severe craniocere-bral injury were divided into long-term group and short-term group. The osmolarity of plasma and cerebiospinal fluid were measured at different time before and during mannitol administration. Results The plasma osmolarity increased quickly at the stage of mannitol treatment, from (300.7±3.3)mOsm/kg·H2O to (323.1 ±5.2)mOsm/kg·H2O at 48h after mannitol administration,and then remained constant. The cerebrospinal fluid osmolarity remained constant at the initial stage of mannitol treatment, but started to increase slowly 24h after the treatment with mannitol in most patients. When the dose of mannitol was halved or halted, the plasma osmolarity quickly decreased, whereas cerebiospinal fluid osmolarity decreased only slightly. The above-mentioned change produced a sharp decrease in the osnolarity gradient between plasma and cerebrospinal fluid, and even the negative osmolarity gradient between them. Conclusions The change in gradients between the plasma and cerebrospinal fluid osmolarity during mannitol administration is closely related to the therapeutic effect of mannitol and 'the rebound phenomenen' of mannitol withdrawal.

关 键 词：甘露醇 重型颅脑损伤 脑脊液 渗透压 测定 

分 类 号：R651.15[医药卫生—外科学]