7.5%高渗盐溶液在合并低血压的颅脑创伤中应用的临床分析

Clinical analysis of 7.5% hypertonic saline on traumatic brain injury with hypotension

目的探讨7.5%高渗盐溶液(hypertonic saline,HTS)对合并低血压的颅脑创伤的早期救治过程中的疗效和应用价值。方法将54例合并低血压的颅脑创伤的患者随机分为两组:高渗盐水组(HTS),甘露醇组(Mannitol,MT);两组分别输注7.5%HTS(4ml/kg)和20%MT(0.5g/kg),分别于用药前和用药后15、30、60、90min和2、3、4、5、6h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蛋白及尿量。结果7.5%HTS对ICP有降低作用,对MAP有升高趋势,对CPP有非常显著的升高作用(P<0.001),其作用高峰时间明显快于20%MT组,且维持时间较20%MT组长。同时7.5%HTS组在用药后2h、5h检测血Na+、血Cl-均有一定的提升趋势,能明显的提高总尿量,对肝肾功能和血氧饱和度无明显影响。结论7.5%HTS在合并低血压的颅脑创伤早期治疗中能有效降低ICP,改善器官血流灌注,且与20%甘露醇相比,起效更快,更持久和更安全。

Objective To investigate the curative effect and application value of 7.5% hypertonic saline（HTS） on early treatment of traumatic brain injury with hypotension.Methods Fifty-four cases were randomly divided into 2 groupa：7.5% HTS group （4ml/kg）,20%MT group （0.5g/kg）, 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 S100B and urinary volume were observed and recorded before the injection and after 15,30,60,90min and 2,3,4,5h respecfively.Results 7.5% HTS to reduce the role of the ICP,the increased trend of the MAP,has a very significant role to increase CPP（ P 〈 0.001 ） ,Its role in the peak time was faster than the 20%MT group,and the maintenance of longer than 20% MT head.At the same time,7.5% HIS in drug use after 2h,5h has a trend to enhance serum Na^＋ ,blood Cl^- significantly,and to rais the total volume of Uringe. As to the liver and kidney function and oxygen saturation has no significant effect. Conclusion In the early treatment stage of s traumatic brain injury complicated with hypotension,7.5 % HTS could effectively reduce ICP, improve blood perfusion of organs as cemparied with MTS, the effects of which is quicker,safer and lasting.