10%高渗盐水联合呋塞米治疗脑梗死后高颅压的疗效和对血钠的影响

Effect of 10%hypertonic saline combined with furosemide on high intracranial pressure after cerebral infarction and its impact on blood sodium

目的探讨10%高渗盐水(HTS)联合呋塞米治疗脑梗死后高颅压的疗效和对血钠的影响。方法选取2020年至2023年桂林市中医医院脑病科住院部诊治的急性大面积脑梗死合并高颅压患者60例,采用数字表随机分为观察1组、观察2组和对照组各20例。其中观察1组(A组)使用10%HTS 60 mL静脉滴注联合呋塞米40 mg微量泵入治疗(具体频次参照颅内压调整),观察2组(B组)使用10%HTS 60 mL静脉滴注治疗,对照组(C组)使用125 mL甘露醇(MT)静脉滴注治疗。连续监测三组患者用药前后颅内压(ICP)和平均动脉压(MAP),并根据ICP和MAP计算相应的脑灌注压(CPP)。记录入组患者有效降低颅内压的持续时间、颅内压的最大降低幅度及持续时间,记录用药前及用药后2 h、6 h的血钠值。结果三组患者的ICP、MAP、CPP、血钠在不同时间段比较差异有统计学意义(P<0.05),用药后2 h、6 h,A组的ICP低于B组和C组(P<0.05),MAP、CPP均高于B组和C组(P<0.05),A组的血钠值低于B组(P<0.05)。结论10%HTS可有效降低急性大面积脑梗死患者的ICP,联合呋塞米可以减少高渗盐水对血钠的影响。

Objective To investigate the efficacy of 10%hypertonic saline(HTS)combined with furosemide in the treatment of intracranial hypertension after cerebral infarction and its influence on blood sodium.Methods A total of 60 patients with acute massive cerebral infarction complicated with high cranial pressure who were treated in the inpatient department of the Encephalopathy Department of Guilin Municipal Hospital of Traditional Chinese Medicine from 2020 to 2023 were selected.They were randomly divided into observation group 1,observation group 2 and control group by digital table,with 20 cases in each group.The observation group 1(group A)were treated with 10%HTS 60 mL by intravenous drip combined with furosemide 40 mg by micro-pump(specific frequency was adjusted according to intracranial pressure),the observation group 2(group B)were treated with 10%HTS 60 mL by intravenous injection,and the control group(group C)were treated with 125 mL mannitol(MT)by intravenous drip.Intracranial pressure(ICP)and mean arterial pressure(MAP)of the three groups were monitored continuously,and corresponding cerebral perfusion pressure(CPP)was calculated according to ICP and MAP.The duration of effective reduction of intracranial pressure,the maximum reduction and duration of intracranial pressure in enrolled patients were recorded,and the blood sodium value before medication,2 hours and 6 hours after medication were recorded.Results ICP,MAP,CPP and blood sodium of the three groups in different time periods were statistically significantly different(P<0.05).After 2 h and 6 h of medication,the ICP of the group A was lower than that of the group B and the group C(P<0.05),MAP and CPP were higher than those of the group B and the group C(P<0.05),and serum sodium value in the group A was lower than that in the group B(P<0.05).Conclusion 10%HTS can effectively reduce ICP in patients with acute large area cerebral infarction,and furosemide can reduce the influence of hypertonic saline on blood sodium.