人血白蛋白与呋塞米配合甘露醇治疗脑出血致脑水肿的临床疗效分析

Analysis of clinical efficacy on combined application of human albumin,mannitol and furosemide in brain edema after intracerebral hemorrhage

目的探讨在甘露醇常规降ICP的基础上,联用人血白蛋白与呋塞米治疗脑出血的效果及合适疗程。方法选取脑出血致脑水肿患者160例,随机编入1个对照组和3个研究组。对照组在基础治疗上予以甘露醇(125ml/次,q8h)降ICP治疗;研究组在对照组的基础上,联用人血白蛋白与呋塞米(1次/d)治疗,3d为一疗程(组间的差异在于疗程不同)。测定治疗前后血肿与水肿体积,记录神经功能变化状况。结果相对于对照组,各研究组治疗后的总有效率、血肿体积、NIHSS评分均优于对照组(P<0.05)。除研究组1外,研究组2和组3水肿体积小于对照组(P<0.05)。研究组1与组2或组3的总有效率、血肿及水肿体积、NIHSS评分相差较大,有统计学意义(P<0.05);研究组2与组3的各项评价指标无统计学差异(P>0.05)。结论人血白蛋白与呋塞米配合甘露醇比单用甘露醇脱水降ICP治疗,能更有效地减轻血肿与水肿及改善神经功能状况,人血白蛋白与呋塞米的疗程在6d左右较为经济合理。

Objective To explore the clinical efficacy and appropriate course of combined with human albumin and furosemide in intracerebral hemorrhage,based on routine reduction of ICP with mannitol.Methods Two hundred patients with brain edema after intracerebral hemorrhage were selected and randomly enrolled into 1 control group and 3 study groups.In the control group,mannitol(125mL/time,Q8h)was given to reduce ICP,in addition to basic treatment;On the basic treatment of the control group,the study group was treated with human albumin and furosemide(once a day),with a course of treatment of 3 days(the difference between groups was the course of treatment).The volume of hematoma and edema before and after the treatment were measured and the changes of nerve function were recorded.Results Compared with the control group,the total effective rate,hematoma volume and NIHSS score after treatment of each study group were all better than those of the control group(P<0.05).Except for Study 1,the edema volume of study 2 or study 3 was smaller than that of control group(P<0.05).The total effective rate,hematoma and edema volume,and NIHSS scores of study group 1 and group 2 or group 3 were significantly different(P<0.05);There were no statistically significant differences of the evaluation indexes between study group 2 and group 3(P>0.05).Conclusion Compared with the treatment of reducing ICP with mannitol alone,the combination of mannitol,human albumin and furosemide can more effectively reduce edema and hematoma,and improve nerve function.?The course of 6 days or so of human albumin and furosemide is more economical and reasonable.