甘露醇对脑功能损伤患者血浆渗透压及其预后影响

Effects of mannitol on plasma osmolality and clinical outcome in patients with brain injury

目的:分析甘露醇对脑功能损伤患者血浆渗透压及其预后的影响。方法:根据患者入院时和入院后2周内所测血浆渗透压及其相关变量,将血浆渗透压增高者列为高渗血症组,血浆渗透压正常或轻度降低者列为非高渗血症组,并对两组危险因素和短期(30天)预后进行分析。结果:脑功能损伤后使用甘露醇脱水降颅压患者306例,90例入院时血浆渗透压异常患者中,高渗血症(血浆渗透压>310mmol/L)72例(80.0%),低渗血症(血浆渗透压≤280mmol/L)18例(20.0%);216例入院时血浆渗透压正常患者在继续甘露醇脱水降颅压治疗后,2周内出现高渗血症的46例,低渗血症6例。单危险因素分析显示中、重度脑功能损伤(GCS评分≤12)、糖尿病、肾病及高甘露醇用量均与高渗血症相关(P<0.05)。多危险因素分析表明,除肾病外,中、重度脑功能损伤患者发生高渗血症危险是轻度脑功能损伤患者的2.6倍;糖尿病患者发生高渗血症危险是非糖尿病患者的2.2倍;甘露醇日用量>100g患者发生高渗血症危险是甘露醇日用量≤100g的1.8倍;甘露醇累积量>1000g患者发生高渗血症危险性是甘露醇累积量≤1000g患者2.6倍。高渗血症患者30天生存率(39.0%)明显低于非高渗血症患者(68.9%),并具统计学意义(P<0.05)。结论:重症脑功能损伤患者甘露醇高日用量和高累计量,可导致或加剧血浆渗透压变化,并可影响患者近期生存率。

Objective： To analyze the effects of marmitol on the plasma osmolality and outcome in patients with brain injury, Methods： According to the plasma osmolality measured on admission and within two weeks after admission, the patients were divided into two groups： hyperosmolality group and hyposmolality group. Risk factors and outcome of short-term （30 days） were analyzed between the two groups. Results： Three hundred and six patients with bran injury were administered with mannitol used for dehydration and reduction of intracranial pressure. Of 90 patients with disturbance of plasma osmolality on admission, 72 had hyperosmolality and 18 had mild hyporsmolality. Of 216 patients with normal plasma osmolality on admission, 46 developed hyperosmolality and 6 occured mild hyposmolality within 2 weeks during the treatment of manmitol used for dehydration and reduction of intracranial pressure, and the rest maintained normal plasma osmolality. Single factor analysis showed that moderate or severe brain injury （GCS≤12）, diabetes mellitus, nephropathy, and high dose of mannitol were significantlly associated with plasma hyperosmolality, Multiple factor analysis showed, that, with the exception of nephropathy, risk of hyperosmolality to patients with moderate and severe brain injury was 2,6 times as high as those with mild brain injury, to diabetic patients was 2.2 times as high as the nondiabetic ones, to patients receiving mannitol 〉 100 g daily was 1.8 times as high as those receiving mannitol ≤100 g daily and to patients receiving 〉 1000 g total dose of mannitol was 2.6 times as high as those receiving ≤1000 g total dose of mannitol. The survival rate of 30 days in patients with plasma hyperosmolality （39,0%）was lower than that in patients without plasma hyperosmolatity （68.9%）, and the difference was statistically significant （P〈 0.05）. Conclusion： High daily dose or cumulative dose of mannitol could induce or aggravate the changes of plasma osmolality, and affect the survival rate of short-term in patients with brain injury.