3%高渗盐水和20%甘露醇治疗重型颅脑损伤合并颅内高压的临床比较观察

Clinical Comparison of 3%Hypertonic Saline and 20%Mannitol in the Treatment of Severe Craniocerebral Injury with Intracranial Hypertension

目的:探究并比较3%高渗盐水(HTS)和20%甘露醇(MT)治疗重型颅脑损伤合并颅内高压的临床疗效差异.方法:选取2018年1月至2019年2月本院诊治的重型颅脑损伤合并颅内高压患者100例为研究对象,按照随机数字表法,分为治疗组和对照组,每组各50例.其中治疗组使用3%HTS,对照组使用20%MT治疗.比较两组患者治疗前后ICP值下降幅度及持续时间,并记录患者不同时间的MAP、CVP、CPP、血钠、血浆渗透压变化及用药后并发症.结果:重复测量方差分析显示,两组患者的ICP、MAP、CPP、血钠及血浆渗透压值的时点、组间、时点与组别的交互效应差异均有统计学意义(P<0.05),CVP的时点与组别的交互效应差异具有统计学意义(P<0.05).且用药1、3、6h后,治疗组的ICP低于对照组,MAP、CVP、CPP、血钠及血浆渗透压均高于对照组,差异具有统计学意义(P<0.05).另两组均伴有脑梗死、迟发性颅内血肿及弥漫性脑肿胀等并发症,治疗组的总发生率为6.00%,对照组为14.00%,两组比较差异不具有统计学意义(χ2=1.778,P>0.05).结论:3%HTS可有效降低重型颅脑损伤患者的ICP,有利于改善患者脑灌注,且对机体循环的影响较小,值得临床推广.

Objective:To explore and compare the clinical efficacy of 3%hypertonic saline(HTS)and 20%mannitol(MT)in the treatment of severe craniocerebral injury with intracranial hypertension Methods:A total of 100 patients with severe craniocerebral injury complicated with intracranial hypertension diagnosed and treated in our hospital from January 2018 to February 2019 were selected as the study objects and divided into treatment group and control group according to the random number table method,with 50 cases in each group.3%HTS was administered to the treatment group and 20%MT was administered to the control group.The magnitude and duration of ICP decline before and after treatment were compared between the two groups,and the changes of MAP,CVP,CPP,serum sodium and plasma osmotic pressure at different times and the complications after treatment were recorded.Results:Repeated measures of variance analysis showed that the interaction effects of ICP,MAP,CPP,serum sodium and plasma osmotic pressure in the two groups were statistically significant at the time point,between the groups,and between the time point and the group(P<0.05),and the interaction effects of CVP were statistically significant at the time point and the group(P<0.05).After 1,3 and 6 h of administration,ICP in the treatment group was lower than that in the control group,and MAP,CVP,CPP,serum sodium and plasma osmotic pressure were higher than those in the control group,with statistically significant differences(P<0.05).The other two groups were accompanied by cerebral infarction,delayed intracranial hematoma,diffuse brain swelling and other complications,the overall incidence of the treatment group was 6.00%,the control group was 14.00%,and the difference between the two groups was not statistically significant(χ2=1.778,P>0.05).Conclusion:3%HTS can effectively reduce ICP in patients with severe craniocerebral injury,which is conducive to improving cerebral perfusion in patients,and has little impact on body circulation,which is worthy of clinical promotion.