脑出血水肿高峰期不同脱水剂对血电解质的影响

Effect of the different dehydrolyzing agents on serum electrolyte during the crest-time of the brain edema of intracerebral hemorrhage

目的探讨脑出血水肿高峰期不同脱水剂对血电解质的影响。方法对362例脑出血患者的临床资料进行系统性回顾,分析脑出血患者非手术治疗过程中分别使用A:甘露醇43例、B:甘露醇+甘油果糖57例、C:甘露醇+甘油果糖+呋塞米104例、D:甘露醇+甘油果糖+托拉塞米158例。监测患者发病后第一周血电解质变化情况。结果 A、B、C和D组中出现电解质紊乱的比例分别为9.3%、7.0%、64.4%和38.6%;各种脱水剂大剂量联合使用均有可能造成血电解质的异常,其中以呋塞米最明显,托拉塞米次之;呋塞米常常引起低钾低钠,而联合使用托拉塞米脱水效果较为明显,并且发生血浆晶体渗透压升高的几率增加。结论大剂量联合应用各种脱水剂均可发生血电解质紊乱,其中以联用呋塞米最明显,联用托拉塞米次之;联用呋塞米常常发生明显低钾低钠,而联用托拉塞米脱水效果明显而出现继发性高钠高钾。

Aim To study the effects of the different dehydrolyzing agents on serum electrolyte during the crest-time of the brain edema of intracerebral hemorrhage.Methods 362 cases of intracerebral hemorrhage patients were divided into four groups according to the dehydrolyzing drugs used.Group A：43 cases treated with mannitol only,group B：57 cases with mannitol and glycerol fructose,group C：104 cases with mannitol,glycerol fructose and furosemide,group D：158 cases with mannitol,glycerol fructose and torasemide.The serum electrolytes of all the patients in the first week after admission were assayed.Results The incidence of serum electrolyte disturbance in group A,B,C and D were 9.3%,7.0%,64.4% and 38.6% respectively.The patients treated with combined dehydrolyzing agents of mannitol,glycerol fructose and furosemide or torasemide showed severer electrolyte disturbance.The most common electrolyte disturbance in group C were hypopotassium and hyponatrium,while in group D were secondum hyperpotassium and hypernatrium,suggesting furosemide and torasemide may have different effects on serum electrolyte.Conclusion High dose of combined dehydrolyzing agents could cause significant serum electrolyte disturbance in the acute phase of intracerebral hemorrhage.Furosemide and torasemide showed different effects on serum electrolyte homeostasis.