高原急性创伤性脑水肿治疗的实验研究

An experimental study on the treatment of acute traumatic brain edema at high altitude

评价２０％甘露醇、７．５％盐水及综合药物治疗（５０％葡萄糖，速尿，地塞米松）对高原急性创伤性脑水肿的治疗效果，探讨在野战环境下治疗高原创伤性脑水肿的可行方案及治疗时机。在减压舱中模拟海拔４０００ｍ高度，制作创伤性脑损伤动物模型，通过测量脑组织水含量、伊文思蓝含量，同时作头颅ＣＴ扫描及光镜观察脑损伤灶的病理变化，以评价脑损伤后不同时间、不同治疗方法对高原创伤性脑水肿的治疗效果。结果表明各治疗组对脑水肿均有一定的治疗作用。其中，甘露醇组和综合治疗组效果优于高渗盐水组；伤后２ｈ用药组优于４ｈ及８ｈ用药组。结果提示甘露醇依然是治疗高原创伤性脑水肿的有效药物，高渗盐水及综合药物治疗对高原创伤性脑水肿也有明显疗效；治疗时间越早，效果越好。在治疗高原创伤性脑水肿的同时，应重视高原环境对心、肺等重要脏器的损害。

To evaluatins the therapeutic effects of 20% mannitol, 7.5% hypertonic saline and combined medication (50% glucose, furosemide and dexamethasone) on acute traumatic brain edema (TBI) at high altitude and explore the feasibility and time of medication to victims of acute traumatic brain edema in the battle field, animal model of mechanical brain injury was established in decompression chamber simulating 4000 m altitude, the contents of water and Evan's blue (EB) in the brain tissue were measured and the pathological changes of the injured area were observed with CT scanning and optical microscopy to evaluate the therapeutic effects of different medication methods on the brain injury at different time posttrauma. It showed that all the three medication methods exerted therapeutic effects on brain edema. The effects of mannitol and combined medication were better than those of hypertonic saline and the early the medication was conducted posttrauma, the better results achieved. It suggests that mannitol is still an effective medicine to treat traumatic brain edema at high altitude and the treatment should be started as early as possible. During the treatment, the functions of the vital organs such as heart and lung must be monitored and comprehensive measures should be undertaken to achieve better results.