等渗透剂量的7.5%高渗盐水和20%甘露醇治疗颅内高压疗效的对比研究

Comparison of 7.5 % Hypertonic Saline and 20 % Mannitol in Doses of Similar Osmotic Burden for Treatment with Intracranial Hypertension

目的:比较等渗透剂量的7.5%高渗盐水(hypertonic saline,HTS)和20%甘露醇治疗颅高压的疗效。方法:当患者的颅内压(intracranial pressure,ICP)超过20 mm Hg时,一组患者接受了4 m L/kg 7.5%HTS(HTS组,n=27),另外一组患者接受了0.5 g/kg 20%甘露醇(甘露醇组,n=31)的降颅压治疗,两种药物均经深静脉在30 min内快速滴注完成。用药期间,连续监测患者ICP,平均动脉压(mean arterial pressure,MAP)、脑灌注压(cerebral perfusion pressure,CPP)及中心静脉压(central venous pressure,CVP)。记录有效降颅压持续时间、ICP最大降幅及其时间,用药前及用药后1 h、3 h、6 h抽血查电解质和血浆渗透压等。结果:静脉快速滴注7.5%HTS和20%甘露醇后,两者均可有效降低ICP(P<0.05)。两组在控制颅高压的有效率、起效时间及ICP降幅无统计学差异(P>0.05),但HTS组的作用持续时间要明显长于甘露醇组(P<0.05)。两组渗透压较用药前相比均有显著上升(P<0.05)。用药前后,两组MAP、CPP和CVP变化无统计学差异(P>0.05)。结论:等渗透剂量的7.5%HTS与20%甘露醇均可有效降低患者的ICP,两者降颅压效果相当,均可作为治疗颅内高压的一线治疗药物。

Objective： To compare the effects of 7.5 % hypertonic saline and 20 % mannitol in doses of similar osmotic burden for treating intracranial hypertension. Methods： A study was conducted with patients showing intracranial pressure （ICP） 〉 20 mmHg lasting for 5 min. Patients were administered either 4 mL/kg 7.5 % hypertonic saline （FITS group, n = 27） or 0.5 g/kg 20 % mannitol （mannitol group, n=31）, intravenously from admission. Two agents were administered as a bolus via a central venous catheter, infused for over 30 min. Data collected from each eligible patient included ICP, plasma osmolarity, electrolytes, and potential adverse effects associated with HTS and mannitol during administration. Results： Both agents were effective in achieving goal ICP （ICP 〈 20 mmHg） during infusion. There were no statistical difference between both groups in the effective rate to control intracranial hypertension, biggest drop in ICP and the mean duration of the effect （P〉0.05）. Plasma osmolarity in two groups increased significantly （P〈0.05）. Conclusion： Treatment with 7.5 % HTS and 20 % mannitol in doses of similar osmotic burden produces is effective and safe for ICP control. Both agents can be recommended as first-line agents in management of raised ICP.