高渗盐水治疗重型颅脑创伤合并休克的疗效研究

Effect of hypertonic saline on treating severe traumatic brain injury combined with shock

目的探讨高渗盐水对重型颅脑创伤合并休克患者的治疗疗效。方法回顾性分析88例严重颅脑创伤合并休克患者的病例资料,根据治疗方案分为两组:A组38例,采用7.5%高渗盐水治疗;B组50例,采用20%甘露醇治疗,监测两组入院后用药4h内各患者颅内压(ICP)、平均动脉压(MAP)、脑灌注压(CPP)和血钠浓度等的变化及评估患者远期的转归。结果 A组和B组比较,用药即时、0.5h、1h时ICP差异均无统计学意义(t分别=-1.92、1.32、0.28,P均>0.05),但A组用药2h和4h时ICP明显低于B组,差异均有统计学意义(t分别=-5.79、-9.32,P均<0.05),且A组患者CPP明显高于B组,差异均有统计学意义(t分别=8.08、7.60,P均<0.05)。两组用药2h内的血钠浓度差异均无统计学意义(t分别=0.86、0.50、0.43、1.83、1.20,P均>0.05)。在远期转归上,两组在6h内死亡率、28d存活率、院内感染率及需处理的高钠血症发生率上差异均无统计学意义(χ2分别=0.54、1.09、0.02、0.12,P均>0.05)。结论重型颅脑创伤合并休克患者早期应用7.5%高渗盐水,不仅能够安全有效地降低ICP,还能够提高患者CPP,有利于休克病人的复苏。

Objective To explore the clinical effect of hypertonie saline on treating severe traumatic brain injury combined with shock. Methods A total of 88 cases of severe traumatic brain injury combined with shock were selected and divided into two groups. All 38 cases of A group received 7.5% hypertonic saline treatment and all 50 cases of B group received 20% mannitol treatment. The intracranial pressure （ICP）, mean arterial pressure （MAP） ,cerebral perfusion pressure（CPP）, serum sodium in 4 hours after treatment and the long-term prognosis were monitored. Results The ICP of two groups had no statistical differences at 0, 30 and 60 minutes （t=-1.92, 1.32, 0.28, P〉0.05） while ICP of A group was significantly lower than that of the B group at 2 and 4 hours （t=-5.79, -9.32, P〈0.05）. And at this time, the CPP of A group was significantly higher than that of the B group（t=8.08, 7.60, P〈0.05）. Nevertheless, the serum sodium had no statistical differences between two groups （t=0.86, 0.50, 0.43, 1.83, 1.20, P〉0.05）. The mortality rate in 6 hours, 28- day survival, infection rate in hospital and hyperuatremia had no statistical differences （X2=0.54, 1.09, 0.02, 0.12, P〉 0.05）. Conclusions The earlier application of 7.5% hypertonic saline was benefit for severe traumatic brain injury combined with shock, which not only reduce intracranial pressure safely and effectively but also be able to improve the patients＇ cerebral perfusion pressure. It was beneficial to shock resuscitation.