高渗盐水治疗急性期大面积脑梗死的临床观察

Clinical Observation of Hypertonic Saline in Treatment of Acute Massive Cerebral Infarction

目的:探讨高渗盐水治疗急性期大面积脑梗死脑水肿的临床疗效。方法:选取本院神经内科收治的急性期大面积脑梗死脑水肿患者46例,所有患者均经头颅CT或MRI检查确诊。按随机数字表法将患者分为两组,每组各23例。观察组(高渗盐水组)使用3%高渗盐水进行脱水治疗,对照组(甘露醇组)使用20%甘露醇进行脱水治疗,比较两组患者治疗前和治疗后神经功能缺损程度(MESSS评分)以及血钠、血钾、血肌酐、血浆渗透压的改变。结果:两组治疗后第3天和第5天后神经功能缺损程度均较前减轻(P<0.01),观察组第5天较对照组减轻更加明显,差异有统计学意义(P<0.05);观察组治疗5 d后血钠、血钾、血肌酐、血浆渗透压均未出现明显异常改变(P>0.05),对照组治疗5 d后出现血钾偏低4例,血肌酐升高伴少尿(急性肾功能不全)1例。结论:3%高渗盐水治疗急性期大面积脑梗死脑水肿疗效确切,不良反应少,值得临床进一步研究和推广应用。

Objective：To investigate the clinical efficacy of hypertonic saline in treatment of acute massive cerebral infarction.Method：46 patients with acute massive cerebral infarction treated in the neurology department of our hospital were selected,all patients were diagnosed by CT or MRI,and the 46 patients were randomly divided into two groups,23 in each group,the observation group（hypertonic saline group）using 3%hypertonic saline for dehydration treatment,the control group（mannitol group）with 20% mannitol dehydration treatment,the degree of neurological impairment（MESSS score ）and the change of the blood sodium,potassium,creatinine ,plasma osmolality was observed in both groups of patients before treatment and after treatment. Result：Three and five days after treatment,the degree of neurological impairment（MESSS score）in both groups of patients were reduced（P〈0.01）,the observation group was significantly more reduced than the control group after five days,the difference was statistically significant（P〈0.05）;five days after treatment,the blood sodium,potassium,serum creatinine,plasma osmolality of the observation group were no obvious abnormalities（P〉0.05）,while in the control group,four cases appear low potassium,one case of elevated serum creatinine with oliguria（acute renal failure）. Conclusion：The efficacy of 3%hypertonic saline in treatment of acute massive cerebral infarction cerebral edema is significant,fewer side effects,worthy of further clinical research and application.