高渗氯化钠羟乙基淀粉40注射液对创伤性脑损伤疗效的观察

Clinical observation of hypertonic sodium chloride hydroxyethyl starch 40 injection in treating traumatic brain injury

目的:观察高渗氯化钠羟乙基淀粉40(HSH40)注射液治疗创伤性脑损伤脑水肿的疗效及安全性。方法:将64例颅脑损伤患者随机分为试验组和对照组(各32例),在综合治疗基础上分别予HSH40和20%甘露醇治疗。检测两组颅内压(ICP)、血浆渗透压、平均动脉压(MAP)、脑灌注压(CPP)、血清Na+浓度、肾功能等指标。结果:与给药前相比较,两组给药后ICP均明显下降(P<0.05),但对照组总的下降水平低于试验组,回升速度也大于试验组,于60 m in时对照组ICP即明显高于试验组,两者差异有统计学意义(P<0.05)。给药后试验组各时间点CPP均高于给药前,并高于对照组同时间点(P<0.05);而对照组与给药前相比无显著性升高,差异无统计学意义(P>0.05)。给药后试验组各时间点血清Na+浓度均高于给药前,并高于对照组同时间点(P<0.05);而对照组较给药前无显著性升高,差异无统计学意义(P>0.05)。两组各时间点血浆渗透压均明显升高,高于给药前(P<0.05)。结论:HSH40治疗创伤性脑损伤后脑水肿效果确切且较为安全,降低ICP效果优于20%甘露醇,能较长时间维持ICP于较低水平,并可同时提高CPP,且肾功能损害等毒副作用轻。

Objective：To observe the effects and safety of hypertonic sodium chloride hydroxyethyl starch 40 injection（HSH40） on brain edema induced by traumatic brain injury.Methods：64 patients diagnosed as traumatic brain injury（TBI） were randomly divided into two groups,both were taken combined treatment.The treatment group（n=32） was treated with HSH40 plus combined therapy;the control group（n=32） was treated with 20% mannitol.Intracranial pressure（ICP）,plasma osmotic pressure,mean arterial pressure（MAP）,cerebral perfusion pressure（CPP）,serum Na＋concentrations,renal function were monitored.Results：ICP decreased significantly in the two groups after the administration,but the augment of ICP decreased in the control group was lower than the treatment group（P〈0.05）.Upswing of ICP decreased in the control group was also faster and its quantitative value was significantly higher than the treatment group at 60 min（P〈0.05）.CPP increased significantly in the treatment groups after the administration in comparison with prior administration and the control group at all times（P〈0.05）.CCP did not significantly increase in the control group（P〈0.05）.Serum Na＋concentrations increased significantly in the treatment group after administration in comparison with prior administration and the control group at all times（P〈0.05）.Serum Na＋concentrations did not significantly increase in the control group（P〈0.05）.Plasma osmotic pressure increased significantly in two groups after the administration（P〈0.05）.Conclusions：HSH40 can be used safely and effectively to reduce ICP and relieve brain edema induced by traumatic brain injury and it is more effective than 20% mannitol.It maintains ICP at a lower level in a prolonged time and raises CPP at the same time without severe renal impairment.