甘露醇联合无创监护方案在急性脑出血患者降低颅内压期间的应用

THE CLINICAL EFFECT OF NON-INVASIVE INTRACRANIAL PRESSURE MONITORING ON PATIENTS WITH ACUTE CEREBRAL HEMORRHAGE TREATED WITH MANNITOL

目的:探讨急性脑出血患者降低颅压治疗期间采用甘露醇联用组无创监护方案的临床效果。方法:选取2013年8月至2015年7月于西安医学院第二附属医院接受治疗的急性脑出血患者210例,按照治疗方式的不同分为对照组、单用组和联用组,每组各70例。其中对照组接受常规治疗,单用组在常规治疗的基础上接受甘露醇静滴治疗,联用组在单用组的基础上应用无创颅内压监测仪监测患者每日的颅内压,记录患者治疗前、后颅内压,对比分析3组患者肾功能指标及日常生活活动能力(ADL)评分情况,单用组和联用组甘露醇使用量等情况。结果:联用组患者颅内压于治疗后第4天开始降低,出院时已降至正常水平。与对照组比较,联用组患者的肾功能指标明显改善,差异有统计学意义(P<0.05);与单用组比较,联用组患者甘露醇使用总量明显减少,差异有统计学意义(P<0.05);与对照组比较,单用组和联用组患者的ADL评分明显升高,且联用组患者的ADL评分高于单用组,差异有统计学意义(P<0.05)。结论:甘露醇有明显降低急性脑出血患者颅内压作用,且联合采用无创监护方案能够明显减少甘露醇使用量,有利于患者ADL的恢复,值得临床推广应用。

Objective： To explore the effect of non-invasive intracranial pressure monitoring on patients withacute cerebral hemorrhage treated with mannitol. Methods： 210 cases of patients with acute cerebral hemorrhagetreated in our hospital from August 2013 toJuly 2015 were selected and divided into 3 groups （70 cases in each group） ： the control group in which thepatients received routine treatments, the single-druggroup in which the patients received mannitol on thebasis of routine treatm ents, and the combo group inwhich the patients were treated as the single-drug group with the addition of non-invasive intracranial pressure measurement. The intracranial pressure wasrecorded at pre- and post-treat merit. The indexes of renal function and Barthel Index （BI） were comparedand analyzed among groups. The total dosage of mannitol was calculated and compared between the singledruggroup and the combo group. Results： The intracranial pressure of the patients in the combo group beganto decrease on the 4th day after treatment, and recovered to the normal level when discharged from thehospital. The renal function was significantly improved in the combo group （ P 〈0. 05 vs. control）. Thetotal dosage of mannitol in the combo group was markedly lower than that in the single-drug group （ P 〈0. 05）. The BI score of the single-drug group and the combo group was significantly elevated when comparedwith that of the control group, while the combo group showed a more significant elevation （ P 〈0.05）. Conclusion ： Mannitol can effectively reduce the intracranial pressure in patients with acute cerebralhem orrhage, and the dosage of mannitol can be decreased with the combination of non-invasive intracranialpressure monitoring. This application may contribute to the recovery of patients^ activities of daily livingand be worthy of clinical application.