低浓度高渗盐水治疗重型颅脑损伤术后颅内高压的临床效果分析

Analysis of the Effect of Low Concentration and Hypertonic Saline on the Intracranial Hypertension after Severe Craniocerebral Injury

目的:探讨低浓度的高渗盐水对重型颅脑损伤患者手术后颅内高压的治疗效果。方法:选取2014年8月至2017年8月本院收治的104例行去骨瓣减压术后出现颅内高压的重型颅脑损伤患者为研究对象,按照随机数表法将其分为实验组、观察组,每组各52例。在持续监测颅内压(ICP)的情况下,实验组、观察组分别给予233.3 m L的3%HS、29.9 m L的23.4%HS,比较两组治疗前后的ICP、平均动脉压(MAP)、中心静脉压(CVP)、血钠(Na+)、钾(K+)、渗透压、肌酐(Cr)、尿素氮(BUN)水平的变化及半年的预后情况。结果:两组治疗后30 min时ICP显著低于治疗前,而MAP明显高于治疗前(P <0.05);实验组治疗后240 min、300 min时ICP显著低于观察组,120 min、240 min、300 min、360 min时MAP均显著高于观察组(P <0.05);两组治疗前后的CVP比较差异无统计学意义(P>0.05)。两组治疗后3 d、6 d血Na+均显著高于治疗前,治疗后1 d、3 d、6 d的渗透压均显著高于治疗前(P <0.05),两组治疗前后的血K+、Cr、BUN比较差异无统计学意义(P>0.05);两组治疗前后的同期各血生化指标比较差异无统计学意义(P>0.05)。实验组治疗半年后死亡6例(11.5%),预后不良14例(26.9%),预后良好32例(61.5%),观察组死亡8例(15.4%),预后不良20例(38.5%),预后良好24例(46.2%),两组比较差异无统计学意义(P>0.05)。结论:3%和23.4%两种浓度的HS均能安全迅速降低重型颅脑损伤患者的ICP,且均有明显的扩容效果,但低浓度HS作用持续时间更长。

Objective： To study the clinical effect of low concentration of hypertonic saline on the postoperative intracranial hypertension in patients with severe craniocerebral injury. Methods： 104 cases of patients with severe craniocerebral injury who experienced intracranial hypertension after craniectomy and admitted in our hospital from August 2014 to August 2017 were selected and randomly divided into the experimental group and the observation group with 52 cases in each group. Under the condition of continuous monitoring of intracranial pressure（ICP）, both groups were treated with 233.3 mL of 3% HS and 29.9 mL 23.4% HS respectively. The changes of ICP, mean arterial pressure（CVP）, serum sodium（Na^＋）, potassium（K＋）, osmotic pressure, creatinine（Cr）, urea nitrogen（BUN） levels were compared before and after treatment between two groups and the prognosis of patients with half a year was recorded.Results： The ICP was lower than that before treatment and the MAP was higher than that before treatment at 30 min after treatment in both groups（P0.05）. There was no significant difference in the ICP, MAP and CVP between the two groups before treatment（P0.05）.The ICP in the experimental group was significantly lower than that in the observation group at 240 min and 300 min, and the MAP in the experimental group was significantly higher than that in the observation group at 120 min, 240 min, 300 min and 360 min（P0.05）.There was no significant difference in the CVP between the two groups before and after treatment（P〈0.05）. The serum Na＋in both groups were significantly higher than that before treatment and at 3 and 6 days after treatment. And the osmotic pressure was significantly higher than that before treatment at 1 d, 3 d and 6 d after treatment（P0.05）. There was no significant difference in the blood K＋, Cr, BUN between the two groups（P〈0.05）. And there was no significant difference in the blood biochemical indexes between the two groups before and after treatment（P0.05）. Six months later, six patients（11.5%） died of disease, 14 cases（26.9%） had poor prognosis, 32 cases（61.5%） had good prognosis in the experimental group, and 8 cases（15.4%） died of disease, 20 cases（38.5%） had poor prognosis and 24 cases（46.2%） had good prognosis in the observation group, there was no statistical difference between the two groups（P〈0.05）.Conclusion： Both 3% and 23.4% concentrations of HS could effectively reduce ICP rapidly in patients with severe craniocerebral injury with safety, but the duration of low concentration of HS was longer.