天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (8): 810-814.doi: 10.11958/20170674

• 专题 颅脑神经创伤 • 上一篇    下一篇

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

杨细平 1， 张馨予 2， 涂悦 1， 商崇智 1， 王飞 3， 张赛 1△   

  1. ： 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
  • 收稿日期:2017-06-09 修回日期:2017-07-14 出版日期:2017-08-15 发布日期:2017-08-15
  • 通讯作者: △通讯作者 E-mail: zhangsai718@vip.126.com E-mail:zhangsai718@vip.126.com
  • 作者简介:杨细平 （1983）， 男， 博士， 主治医师， 主要从事颅脑损伤的救治及亚低温脑保护等方面研究
  • 基金资助:
    1 武警后勤学院科学研究基金资助项目（WHJ2015021）； 2 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）

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

YANG Xi-ping1, ZHANG Xin-yu2, TU Yue1, SHANG Chong-zhi1, WANG Fei3, ZHANG Sai1△   

  1. 1 Department of Neurosurgery, the Affiliated Hospital of Logistics University of Chinese People’ s Armed Police Forces, Tianjin 300162, China; 2 Institute of Biochemistry and Molecular Biology, Logistics University of Chinese People’ s Armed Police Forces; 3 Department of Cardiology, the Affiliated Hospital of Logistics University of Chinese People’ s Armed Police Forces
  • Received:2017-06-09 Revised:2017-07-14 Published:2017-08-15 Online:2017-08-15
  • Contact: △Corresponding Author E-mail: zhangsai718@vip.126.com E-mail:zhangsai718@vip.126.com

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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。

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

Abstract: Objective To study the effects of different concentrations of hypertonic saline (HS) and 20% mannitol on decreasing intracranial pressure (ICP) in patients with moderate-sever traumatic brain injury (TBI). Methods A total of 60 patients were randomly assigned into 7.5% HS group, 3% HS group and 20% mannitol group, 20 patients in each group. All of patients were treated with conventional treatment according to the diagnostic and treatment practices of TBI. When ICP was above 20 mmHg for more than 5 minutes, patients were administered corresponding hypertonic dehydrator. The levels of ICP, mean arterial pressure (MAP), cerebral perfusion pressure (CPP), urine volume per hour and serum sodium were monitored continuously within 6 hours after the initiation of therapy. Results All agents could significantly decrease the ICP (P < 0.05), but the onset time in 7.5% HS group was less than that of the other two groups (P < 0.05), and the decreased magnitude of ICP and the effective time of decreasing ICP in 7.5% HS group were more than those of the other two groups (P < 0.05). Both 7.5%HS and 3%HS could increase MAP and CPP. There was no statistical difference in serum sodium between both groups , but the diuretic effect in both groups was worse than that of 20% mannitol group. Conclusion The rapidly infusion of 7.5% HS could significantly decrease the ICP, increase the MAP and CPP without obvious side-effect in patients with moderate- sever TBI, and which is a safe and effective therapy for intracranial hypertension after traumatic brain injury．

Key words: craniocerebral trauma, saline solution, hypertonic, mannitol, intracranial pressure, diuresis, mean arterial pressure, cerebral perfusion pressure