高渗盐水对大脑半球大面积梗死患者大脑中动脉血流动力学参数的影响

Effect of hypertonic saline on the hemodynamic parameters of middle cerebral artery inpatients with large cerebral hemisphere infarction

目的经颅多普勒超声(TCD)记录大脑半球大面积脑梗死(LHI)患者大脑中动脉(MCA)4项血流动力学参数,评价高渗盐水(HTS)治疗对降低颅内压(ICP)的作用。方法17例LHI患者作为研究组,19例健康人群作为对照组;通过TCD采集MCA的收缩峰流速(Vs)、舒张末期流速(Vd)、平均流速(Vm)以及脉动指数(PI)4项指标,比较研究组患者HTS治疗前与对照组MCA 4项指标的差异,比较研究组患者HTS治疗前后MCA 4项指标的差异;通过格拉斯哥昏迷指数评分(GCS)和美国国立卫生院神经功能缺损评分(NIHSS)评估疗效,监测血钠、血氯、血钾和肾功能了解并发症发生率。结果与对照组比较,研究组HTS前Vd、Vm降低,PI升高,差异均具有统计学意义(P<0.05),其中PI差异最为明显(P<0.001);研究组HTS后与HTS前比较,Vd、Vm升高,PI降低,差异均具有统计学意义(P<0.05),其中PI差异最为明显(P<0.001);1例LHI治疗到第3天放弃治疗,16例LHI患者连续治疗5 d,GCS评分和NIHSS评分与HTS前比较、差异无统计学意义(P>0.05);LHI患者治疗后2例血钠155~160 mmol/L,3例发生低钾血症,6例发生高氯血症。结论HTS治疗LHI可有效降低ICP,TCD可以通过观察MCA的Vd、Vm以及PI了解LHI患者的ICP变化。

Objective To evaluate the effect of hypertonic saline on reducing intracranial pressure(ICP)using 4 hemodynamic parameters of MCA in patients with large hemispheric infarction(LHI)determined by transcranial Doppler(TCD).Methods A total of 17 patients with LHI were selected as study group,and 19 healthy people were selected as control group.TCD was used to record systolic peak velocity(Vs),diastolic velocity(Vd),mean velocity(Vm),and pulsatility index(PI)of MCA.The differences of four indexes of MCA between the study group before HTS treatment and the control group was compared.The difference of four indexes of MCA in study group was compared before and after HTS treatment.The efficacy was evaluated by Glasgow Coma Scale(GCS)and National Institute of Health Stroke Scale(NIHHS),and the incidence of complications was interpreted by monitoring blood sodium,blood chlorine,blood potassium and renal function.Results Compared with control group,Vd,and Vm in study group were decreased before HTS,but PI increased(P<0.05),among which the difference in PI was the most obvious(P<0.001).When compared to before HTS,Vd,and Vm increased and PI decreased after HTS treatment in study group(P<0.05),among which PI had the biggest difference(P<0.001).Sixteen patients with LHI were continuously treated for 5 days,the GCS score and NIHSS score were not statistically significant when compared with those before HTS(P>0.05).After treatment,LHI patients had serum sodium>155 mmol/L(<160 mmol/L)(n=2),hypokalemia(n=3)and hyperchloremia(n=6).Conclusion HTS treatment can effectively reduce lCP.TCD-offered Vd,Vm,and PI of MCA can be used to monitor ICP changes.