高渗盐水联合硫酸镁治疗重型颅脑损伤的临床研究

Effect of hypertonic saline combined with magnesium sulfate on severe craniocerebral injury

目的探讨高渗盐水联合硫酸镁治疗重型颅脑损伤患者的疗效。方法前瞻性选择嘉兴学院附属第二医院神经外科自2017年9月至2019年2月收治的重型颅脑损伤患者,在患者家属知情同意的情况下,将患者按随机数字表法分为对照组、实验组。2组患者均接受颅内压监护治疗,实验组患者在该治疗的基础上加用高渗盐水联合硫酸镁治疗,连续使用7 d,比较2组患者颅内压监护期间高颅内压、癫痫、低灌注压、脑血管痉挛、脑梗死及颅内压反跳的发生率,伤后1周甘露醇总用量、血清神经元特异烯醇化酶(NSE)浓度,伤后3个月患者的格拉斯哥预后量表(GOS)评分及死亡率。结果共纳入重型颅脑损伤患者93例,其中实验组患者46例,对照组患者47例,2组患者的年龄、性别、入院时格拉斯哥昏迷量表(GCS)评分和血清NSE浓度、开颅血肿清除术和去骨瓣减压术者所占比例差异均无统计学意义(P>0.05)。与对照组比较,实验组患者伤后1周甘露醇总用量、血清NSE浓度较低,伤后3个月GOS评分较高,差异均有统计学意义(P<0.05)。与对照组比较,实验组患者高颅内压、脑血管痉挛、颅内压反跳的发生率较低,差异均有统计学意义(P<0.05)。结论高渗盐水联合硫酸镁治疗重型颅脑损伤能改善患者预后,而且副作用少,有可能成为一种较理想的脑保护剂。

Objective To explore the effect of hypertonic saline combined with magnesium sulfate on severe craniocerebral injury.Methods Patients with severe craniocerebral injury admitted to our hospital from September 2017 to February 2019 were selected prospectively.With the informed consent of the patients'families,the patients were divided into control group and experimental group according to the random number table.Patients in the two groups accepted intracranial pressure monitoring;patients in the experimental group additionally accepted magnesium sulfate combined with hypertonic saline for a continuous use of 7 d.Incidences of high intracranial pressure,epilepsy,low intracranial perfusion,cerebral vasospasm,cerebral infarction,and intracranial pressure rebound,total mannitol dosages one week after injury,serum neuron specific enolase(NSE)level,and Glasgow outcome scale(GOS)scores and mortality rate 3 months after injury were analyzed and compared between the two groups.Results A total of 93 patients were enrolled;47 were into the control group and 46 into the experimental group.There were no significant differences in age,gender,Glasgow coma scale(GCS)scores and NSE levels at admission,and percentages of patients accepted craniotomy evacuation of hematoma or bone flap decompression between the two groups(P>0.05).As compared with those in the control group,the total mannitol dosage one week after injury and serum NSE concentration were significantly lower,and GOS scores 3 months after injury in the experimental group were significantly higher(P<0.05).Patients in the experimental group had significantly lower incidences of high intracranial pressure,cerebral vasospasm and intracranial pressure rebound as compared with patients in the control group(P<0.05).Conclusion Hypertonic saline combined with magnesium sulfate can improve the prognoses of severe craniocerebral injury;it has few side effects and is cheap;it might be an effective cerebral protective agent.