高渗盐水和甘露醇对急性脑出血患者脑水肿治疗的临床对比分析

Effects of hypertonic saline and mannitol in treatment of acute intracranial hemorrhage： comparative study of 12 cases

目的10％高渗盐水（Hs）和20％甘露醇（MT）治疗急性脑血管病的临床对比分析。方法12例急性脑出血患者均接受10％HS75ml和20％MT250ml脱水各1次，治疗顺序随机决定。用药后6h内观察平均动脉压（MAP）、中心静脉压（CVP）、脑电图双频谱指数（BIS）及血钠浓度和血浆渗透压的变化。结果10％HS组可使MAP升高（P〈0．05），而20％MT组MAP无显著变化；两组治疗前后及组间比较CVP变化不显著；两组均能提高BIS值改善脑灌注（P〈0．05），10％HS作用更强，持续时间更长（P〈0．05）；10％HS治疗后血钠浓度和血浆渗透压有轻度增高，而MT组呈轻度下降，两组间血钠浓度差异有统计学意义（P〈0．05）。结论10％HS可维持MAP，稳定血钠水平和血浆渗透压，有效改善脑灌注，可作为减轻急性脑出血性脑水肿药物的替换性选择。

Objective To compare the clinical effects of 10% hypertonic saline （HS） and 20% mannitol （MT） in treatment of acute intracranial hemorrhage. Methods Twelve acute intracranial hemorrhage patients were randomly divided into 2 equal groups to undergo perfusion of 10% HS 75 ml Q8h or Q6h for 12 times first and then undergo perfusion of 20% MT 250 ml Q8h or Q6h for 12 times （HS group）, or undergo perfusion of 20% MT 250 ml Q8h or Q6h for 12 times first and then undergo perfusion of 10% HS 75 ml Q8h or Q6h for 12 times （MT group）. Before the treratment and 6h after the initiation of treatment mean arterial pressure （MAP）, central venous pressure （CVP）, and electroencephalogram bispectral index （BIS） were measured, serum sodium was tested, and plasma osmotic pressure was calculated. Result The MAP of the HS group increased after the initiation of treatment, peaked 0.5 h later, and kept high until 4 h after （all P〈0.05）. However, the MAP at any time point of the MT group did not show significant changes （all P〈0.05）. 1.5-4 h after the initiation of treatment the MAP levels of the HS group were all significantly higher than those of the MT group （all P〈 0.05）. CVP showed no significant differences after treatment in both groups. The BIS values of both groups significantly increased, and those of the HS group were significantly higher than those of the MT group. The values of serum sodium and plasma osmotic pressure of the HS group were slightly and not significantly increased （P〉0.05）, and those of the MT group was slightly and not significantly decreased （P〉0.05）. However, those values 6 h after the initiation of treatment of the HS group were both significantly higher than those of the MT group （both P〈0.05）. The serum sodium level decreased after MT use and increased after HS use（P〈0.05）. Conclusion 10% HS solution effectively maintains MAP, serum sodium and plasma osmitic pressure, thus effectively improving the intracranial infusion.