高原地区甘露醇联合白蛋白及呋塞米治疗脑挫裂伤后脑水肿疗效的临床与CT观察及预后分析

Clinical and CT Observation of Mannitol Combined with Albumin and Furosemide in the Treatment of Brain Edema after Cerebral Contusion and Prognostic Analysis at Plateau Area

目的探讨高原地区脑挫裂伤后脑水肿经甘露醇联合白蛋白及呋塞米治疗后的CT表现与疗效分析。方法将30例脑挫裂伤患者随机分为研究组及对照组,每组15例。研究组给予甘露醇+白蛋白+呋塞米治疗,对照组只给予甘露醇治疗。通过对治疗后第1、3、5、7、10天颅脑CT征象变化、格拉斯哥昏迷量表(GCS)评分及血清白蛋白水平的分析,评估两组患者治疗前后的脑水肿指数以及对预后的影响。结果治疗后第1天,两组患者颅脑CT征象变化无统计学差异(P>0.05),治疗后第3、5、7、10天研究组患者CT呈现损伤区水肿量显著低于对照组(P<0.05);治疗后第1天两组患者脑水肿指数无统计学差异(P>0.05),治疗后第3、5、7、10天研究组患者水肿指数显著低于对照组(P<0.05);治疗后第1、3天两组患者GCS评分无统计学差异(P>0.05),治疗后第5、7、10天研究组患者GCS评分显著高于对照组(P<0.05);两组患者在入院当天及治疗后第1天血清白蛋白无统计学差异(P>0.05),在治疗后第5、10天,研究组患者血清白蛋白水平显著高于对照组(P<0.05)。结论高原地区甘露醇联合人血白蛋白和呋塞米治疗脑挫裂伤后脑水肿疗效确切,可明显缩短脑水肿的病理进程。颅脑CT对于脑挫裂伤患者是一项经济而有效的疗效评价方法。

Objective To investigate the CT findings of mannitol combined with albumin and furosemide in the treatment of brain edema after traumatic brain injury and its influence on prognosis at plateau area.Methods The intervention group was treated with mannitol+albumin+furosemide(Manni+ALB+Furos),while the control group was treated with mannitol only.The brain edema index and prognosis of the two groups before and after treatment were evaluated by analyzing the changes of CT signs,GCS scores and serum albumin levels after trauma.Results On the 1 st day after treatment,there was no significant difference in CT signs between the two groups(P>0.05).On the 3 rd,5 th,7 th and 10 th day after treatment,the edema in the injured area in the intervention group was significantly lower than that in the control group(P<0.05);On the 1 st day after injury,there was no significant difference in brain edema index between the two groups(P>0.05).On the 3 rd,5 th,7 th and 10 th day after injury,the brain edema index of the intervention group was significantly lower than that of the control group(P<0.05);There was no significant difference in GCS score between the two groups on the 1 st and 3 rd day after injury(P>0.05).The GCS score of the intervention group was significantly higher than that of the control group on the 5 th,7 th and 10 th day after injury(P<0.05);There was no significant difference in serum albumin between the two groups on the admission day and the 1 st day after injury(P>0.05).On the 5 th and 10 th day after injury,the serum albumin level of the intervention group was significantly higher than that of the control group(P<0.05).Conclusion Mannitol combined with human albumin and furosemide is effective in treating brain edema after cerebral contusion and laceration at high altitude,which can significantly shorten the pathological process of brain edema.