地塞米松联合甘露醇治疗对急性重症脑血管病脑保护作用的临床观察

Clinical Observation of the Protective Effect of Dexamethasone Combined with Mannitol on the Cerebral Protection of Acute Severe Cerebrovascular Disease

目的观察地塞米松联合甘露醇应用于急性重症脑血管病脑保护作用。方法选取2018年5月~2019年5月在我院诊治的98例急性重症脑血管病患者为研究对象,采用随机数字表法分为对照组和观察组,各49例。对照组采用甘露醇治疗,观察组在对照组基础上联合地塞米松治疗,比较两组患者颅内压(ICP)检测情况(正常、轻度、中度、重度)、ICP恢复正常时间段比例、格拉斯哥昏迷(GCS)评分情况、病死率以及并发症发生情况。结果观察组颅内压轻度、中度、重度升高发生率与对照组比较,差异无统计学意义(P>0.05);观察组1~2 d、3~4 d患者ICP恢复正常发生率均高于对照组,5~6 d、7 d及以后发生率均低于对照组,差异有统计学意义(P<0.05);观察组GCS评分3~8分发生率低于对照组,9~12分、13~14分发生率均高于对照组,差异有统计学意义(P<0.05);观察组病死率为12.24%,低于对照组的14.28%,差异无统计学意义(P>0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论临床采用地塞米松联合甘露醇应用于急性重症脑血管病治疗可减轻颅内压升高程度,缩短ICP恢复时间,提高GCS评分,降低颅内压,具有显著的脑保护作用。同时不会增加并发症,影响病死率,具有显著的临床应用价值。

Objective To observe the protective effect of dexamethasone combined with mannitol in acute severe cerebrovascular disease.Methods A total of 98 patients with acute severe cerebrovascular disease diagnosed and treated in our hospital from May 2018 to May 2019 were selected as the research objects,and were divided into the control group and the observation group by random number table method,with 49 cases in each group.The control group was treated with mannitol,and the observation group was treated with dexamethasone on the basis of the control group.The intracranial pressure(ICP)detection status(normal,mild,moderate,severe)of the two groups of patients was compared,and the ratio of the time period when ICP returned to normal,Glasgow coma(GCS)score,case fatality rate and complications.Results Compared with the control group,the incidence of mild,moderate,and severe increases in intracranial pressure in the observation group was not statistically different(P>0.05);the incidence of ICP returned to normal in patients in the observation group on 1-2 d and 3-4 d Higher than the control group,the incidence rates of 5-6 d,7 d and later were lower than those of the control group,the difference was statistically significant(P<0.05);the incidence of GCS scores of 3-8 points in the observation group was lower than that of the control group,the incidence rates of 9-12 points and 13-14 points were higher than those of the control group,the difference was statistically significant(P<0.05);the mortality rate of the observation group was 12.24%,which was lower than the control group's 14.28%,the difference was not statistically significant(P>0.05);There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusion The clinical application of dexamethasone combined with mannitol in the treatment of acute severe cerebrovascular disease could reduce the increase in intracranial pressure,shorten the recovery time of ICP,increase the GCS score,reduce intracranial pressure,and had a significant brain protection effect.At the same time,it would not increase complications and affect the mortality rate,and had significant clinical application value.