高渗盐水治疗对重型颅脑创伤APACHEⅡ评分和GCS评分的影响

Influences of hypertonic saline on APACHE Ⅱ score and GCS score in patients with severe traumatic brain injury

目的探讨高渗盐水对重型颅脑创伤患者急性生理和慢性健康评分系统Ⅱ(APACHEⅡ)评分和格拉斯哥昏迷(GCS)评分的影响。方法 40例重型颅脑创伤患者随机分为高渗盐水组(n=18)和甘露醇组(n=22)。在常规治疗基础上,高渗盐水组和甘露醇组分别以75 g/L高渗盐水和200 g/L甘露醇治疗,比较两组治疗前后APACHEⅡ评分和GCS评分。结果两组治疗前APACHEⅡ评分[高渗盐水组:(25.36±8.56)分;甘露醇组:(26.78±9.20)分]和GCS评分[高渗盐水组:(6.04±1.23)分;甘露醇组:(6.45±1.09)分]差异均无统计学意义(P>0.05)。高渗盐水组治疗后第1、2、3天APACHEⅡ评分[分别为(22.02±5.45)、(19.36±5.26)、(16.64±3.82)分]明显低于治疗前.亦低于甘露醇组[治疗后第1、2、3天分别(25.69±7.31)、(23.26±6.85)、(19.35±5.33)分](均P<0.05);治疗后GCS评分与治疗前及甘露醇组治疗后比较差异无统计学意义(均P>0.05)。结论早期高渗盐水治疗能改善重型颅脑创伤患者的APACHEⅡ评分。

Objective To investigate the influence of hypertonic saline on APACHE Ⅱ score and GCS score in patients with severe traumatic brain injury. Methods Forty patients with severe traumatic brain injury were divided into two groups randomly： the hypertonic saline （HTS） group （18 cases） and the mannitol （MT） group （22 cases）. On the basis of conventional therapy; hypertonic saline （75 g/L） and mannitol （200 g/L） were injected in the two groups respectively. APACHE Ⅱ score and GCS score before and after treatment were compared. Results Before the treatment, there was no significant difference of the APACHE Ⅱ score [ HTS： （25.36±8.56）; MT： （26.78±9.20）] and the GCS score [HTS： （ 6.04±1.23）; MT： （6.45±1.09） ] between the two groups （P〉0.05）. APACHE H scores were significantly decreased in HTS group （22.02±5.45）, （19.36±5.26）, （16. 64±3. 82） atdayl, 2, 3aftertreatment] （all P 〈 0.05）. As compared with MT group [ （25.69±7.31）, （23.26±6.85）, （19.35±5.33） at day 1, 2, 3 after treatmentS, APACHE Ⅱ scores were significantly decreased in HTS group （all P〈0.05）, but the GCS scores were not significantly increased （P〉0.05） in HTS group after treatment. And there were no significant differences of the GCS scores between the two groups. Conclusions Hypertonic saline using on the early stage could decrease the APACHE Ⅱ score in severe traumatic brain injury.