高渗盐水在重型颅脑外伤合并休克早期的疗效分析

Curative effect of hypertonic saline on severe traumatic brain injury with shock

目的探讨7.5%高渗盐溶液(hypertonic saline,HTS)在(特)重型颅脑外伤,尤其合并休克患者早期救治过程中的治疗效果,以及对降低颅内压、改善脏器血流灌注和抗休克治疗的影响。方法将60例重度颅脑外伤合并休克的患者随机分为2组:高渗盐水组(HTS),甘露醇组(Mannitol,MT);2组分别输注7.5%HTS(4ml/kg)和20%MT(0.5g/kg),分别于用药前和用药后15、30、60、90、120分钟和3、4、5小时持续监测颅内压(ICP)、平均动脉压(MAP)、中心静脉压(CVP)、脑灌注压(CPP)、生命体征、血氧饱和度(SaO2)、血生化指标(肝肾功能、电解质及二氧化碳结合力)、S100B蛋白及记录尿量。结果HTS能明显降低ICP,减轻脑水肿,改善脑血流灌注及提高心排出量,并且对血生化指标和尿量无影响,从而有效地复苏失血性休克。结论HTS在重型颅脑外伤合并休克早期治疗中能有效降低ICP,改善器官血流灌注,且与甘露醇相比,起效更快,更持久和更安全,同时能改善失血性休克发生时的血流动力学指标和纠正休克引起的相应病理生理改变。

Objective To investigate the curative effect of 7.5% hypertonic Saline（HTS） on severe traumatic brain injury with shock, and on depressing intracranical pressure and improving blood perfusion of organs. Methods Sixty cases were randomly divided into 2 groups （ HTS group, MT group） ,7.5% HTS （4ml/kg） and 20% MT（0.5g/kg） group. Intracranical pressure（ ICP）, mean arterial pressure（MAP） ,central venous pressure（ CVP）, cerebral perfusion pressure （ CPP ） , vital signs, SaO2, hepatic function, renal function, plasma electrolytes, blood sugar, protein S 100B and urinary volume were observed and recorded 15,30,60,90,120 min and 3,4,5 h before and after the injection respectively. Results HTS decreased ICP,lessen cerebral edema, improved cerebral blood perfusion and increased cardiac output obviously,and had no bad effect on plasma electrolytes and urinary volume. HTS was effective in the treatment of hemorrhagic shock. Conclusion In the early treatment stage of severe traumatic brain injury complicated with shock, HTS could effectively reduce ICP, improve blood perfusion of organs as comparied with MTS,the effects of which is quicker,safer and lasting. HTS could improve dynamic index of circulation caused by hemorrhagic shock,and correct relative pathophysiologic changes caused by shock.