不同剂量甘露醇单用或合用速尿治疗颅高压的疗效观察

Therapautic effects of treating intracranial hypertension with different dosage Mannitol alone or combined with Furosemide

目的观察不同剂量甘露醇单用或合用速尿治疗颅高压的疗效。方法对60例各种原因行脑外科手术后出现颅内压增高的患者、依据使用不同剂量甘露醇单用或加用速尿而分为半量甘露醇（0．5g／kg）组（A组）、全量甘露醇（1．0g／kg）组（B组）、半量甘露醇＋速尿（20mg）组（C组）及全量甘露醇＋速尿（20mg）组（D组），通过颅内压监测，观察各组降低颅内压的效率、血浆渗透压及肾功能改变。结果（1）在降低颅内压的有效率、颅内压反跳率、药效持续时间上，C、D组明显优于A、B组（均P〈0．05）；降压幅度4组间差异无显著性。（2）连续降颅压治疗第5d及第7d时，各组均出现血浆渗透压的升高，与C组相比，B、D组升高更明显（P〈0．05～0．01）。（3）连续使用甘露醇第5d、7d，与C组相比，B、D组血尿素氮、肌酐明显升高（均P〈0．05）。结论半量甘露醇＋速尿治疗颅内压增高疗效佳、安全性高。

Objective To study the effects of treating intracranial hypertension （ICP） with different dosage Mannitol alone or combined with Furosemide. Methods 60 patients with high ICP after all kinds of operations on cranium and brain were divided into 4 groups according to the dosage of Mannitol alone or combined with Furosemide ：0. 5 g/kg Mannitol （group A） , 1.0 g/kg Mannitol （group B） , 0. 5 g/kg Mannitol and 20 mg Furosemide （group C）, 1. 0 g,/kg Mannitol and 20 mg Furosemide （group D）. The effective power, rebound ratio, average effective time, average amplitude of decreasing ICP, plasma osmolarity and renal function were evaluated by monitoring intracranial pressure. Results In response of the effective power, rebound ratio of ICP and average effective time, groups C and D were more noticeable than groups A and B （ all P 〈 0. 05 ）. There was no statistical difference in the average amplitude of decreasing ICP among 4 groups. The value of plasma osmolarity raised on the 5th day and 7th day after using Mannitol alone or combined with Furosemide in each group. The increases in groups B and D were more remarkabe than that in group C （ P 〈 0. 05 - 0. 01）. Compared with group C, the BUN and Cr in groups B and D raised remarkably after continuous using Mannitol for 5 days and 7 days （ all P 〈0. 05 ）. Conclusion Mannitol （0. 5 g/kg） combined with Furosemide （20 mg） is more effective and safer in decreasing intracranial hypertension.