高渗盐复合液在脑外伤并未控制失血性休克中的临床疗效评价

Hypertonic Saline Solution in Traumatic Brain Injury Combined with Hemorrhagic Shock did not Control the Clinical Evaluation

目的:探讨高渗盐复合液(缩写HSH,其中氯化钠的浓度为4.2%,羟乙基淀粉40为7.6%)对重型颅脑外伤,颅内高压并休克的临床疗效评价及其可能的作用机制,及其与传统液体复苏相比的优势。方法:将符合重型颅脑外伤,颅高压并体克的患者80例随机分为高渗盐复合液+甘露醇复苏组(实验组)40例;传统液体+甘露醇复苏组(对照组)40例。对两组患者不同时间点的心率、收缩压、输液量、ARDS、MODS发生率、病死率等进行统计与评价分析。结果:两组的心率、尿量变化和平均动脉压差异T1-T3有显著性(P<0.05),T0、T4无显著性(P>0.05)。高渗盐水组液体总量1205±322ml明显小于对照组,2147±674ml,P<0.01(t=8.839);其ARDS、MODS、病死率均低于对照组(P<0.05)。结论:对于急性颅内高压伴失血性休克的患者,高渗盐复合液能更快更有效的纠正休克时组织低灌注,保护重要脏器的功能和降低颅内压,减少输液量,降低ARDS、MODS的发生率及病死率。

Objective：To study the combined hypertonic saline solution（abbreviation HSH,in which the density of sodium chloride 4.2%40,7.6%hydroxyethyl starch）on the acute intracranial epidural hematoma and shock,which the clinical evaluation,possible mechanism,and advantages compared to conventional fluid resuscitation.Mehtord：Intracranial hypertension and uncontrolled traumatic hemorrhagic shock of 80patients were randomly divided into combined fluid＋ mannitol hypertonic resuscitation group（experimental group 40cases）,conventional liquid＋ mannitol hypertonic resuscitation group（control group 40cases）.Compared two groups of patients at different time points on the heart rate,systolic blood pressure,preoperative total infusion volume,ARDS,MODS mortality by statistical analysis to evaluate the analysis.Results：In both groups heart rate,urine volume and mean arterial pressure difference during T1-T3changed significantly（P0.05）,but T0、T4have no different.Hypertonic saline group was significantly lower than control groupe on fluid volume[（1 205±322）ml,（2147±674）ml,P0.05],the ARDS,MODS,mortality rates were lower than the control group（ARDS2,8,MODS3,10,mortality 5%,22.5%,P0.05）.Conclusion：Acute intracranial hypertension with hemorrhagic shock in patients,HSH can correct shock,reduce intracranial pressure,reduce the amount of preoperative transfusion,and reduce ARDS,MODS incidence and mortality.