高渗盐水联合甘露醇治疗重型颅脑损伤后颅内压增高患者预后改善的效果观察

Observation on the efficacy of hypertonic saline combined with mannitol on improving prognosis of patients with increased intracranial pressure after severe craniocerebral injury

目的探讨在重型颅脑损伤后颅内压增高患者治疗过程中,为患者采用高渗盐水联合甘露醇治疗的效果,以及预后改善效果。方法随机选取我院于2017年8月至2019年8月进行疾病治疗的重型颅脑损伤后颅内压增高患者,共计70例,以随机数字表法的形式,将其分成试验组和参照组,每组各35例。参照组行甘露醇治疗,试验组实施高渗盐水联合甘露醇治疗。比较和分析治疗前后两组格拉斯哥昏迷评分(GCS)的变化以及治疗情况、颅内压负荷情况、不同时间段两组的血清神经元特异性烯醇化酶的水平变化、治疗1年后两组患者的预后效果。结果治疗后,试验组的GCS评分高于参照组,差异有统计学意义(P<0.05);试验组的住院天数短于参照组,差异有统计学意义(P<0.05);试验组的颅内压负荷累积率、每日颅内压负荷时间均低于参照组,差异有统计学意义(P<0.05);在第3、5、7天,试验组的血清神经元特异性烯醇化酶的水平均低于参照组,差异有统计学意义(P<0.05);治疗1年后,试验组的预后优于参照组,差异有统计学意义(P<0.05)。结论通过实验比较可知,对重型颅脑损伤后颅内压增高患者实施高渗盐水联合甘露醇治疗,能够降低颅内增强的情况,有助于病症的缓解,预后效果显著,值得临床广泛推广与应用。

Objective To investigate the efficacy of hypertonic saline combined with mannitol on improving prognosis of patients with increased intracranial pressure after severe craniocerebral injury,and to improve the prognosis efficacy.Methods In the form of random number table,a total of 70 patients with increased intracranial pressure after severe craniocerebral injury who were treated in our hospital from August 2017 to August 2019 were randomly selected,and they were divided into the experimental group(n=35)and the control group(n=35).The control group was treated with mannitol,while the experimental group was treated with hypertonic saline combined with mannitol.Before and after treatment,the changes of Glasgow coma scale(GCS)scores,treatment conditions,intracranial pressure load conditions,changes of serum neuron-specific enolase levels of the two groups at different time periods and prognostic efficacies of two groups after 1 year of treatment were compared and analyzed.Results After treatment,the GCS score of the experimental group was higher than that of the control group,with statistically significant difference(P<0.05).The hospitalization days in the experimental group were shorter than those in the control group,with statistically significant difference(P<0.05).The cumulative rate of intracranial pressure load and daily intracranial pressure load time in the experimental group were both lower than those in the control group,with statistically significant differences(P<0.05).On the 3rd day,the 5th day and the 7th day,the levels of serum neuron-specific enolase in the experimental group were all lower than those in the control group,with statistically significant differences(P<0.05).After 1 year of treatment,the prognosis of the experimental group was more satisfying than that of the control group,with statistically significant difference(P<0.05).Conclusion Through experimental comparison,it can be seen that hypertonic saline combined with mannitol in the treatment of patients with increased intracranial pressure after severe craniocerebral injury can reduce the situation of intracranial enhancement and it is conducive to relieving symptoms.Therefore,it has significant prognosis efficacy,which is worthy of wide promotion and application in clinic.