高渗钠溶液在闭合性颅脑外伤后颅内压增高中的救治效果

目的:分析闭合性颅脑外伤后颅内压(ICP)增高患者救治过程中应用高渗钠溶液的效果。方法:选择2021年1月—2022年9月接受治疗的闭合性颅脑外伤后颅内压增高患者60例,利用随机数表法分为对照组和观察组,每组30例。对照组给予甘露醇治疗,观察组给予3%高渗钠溶液治疗。比较两组患者的颅内压、平均动脉压(MAP)以及颅内灌注压(CPP)变化情况;比较两组患者预后、伤后6个月病死率以及并发症发生情况。结果:治疗前两组患者的ICP和MAP及CPP比较,差异无统计学意义(P>0.05)。治疗后30 min和60 min两组ICP均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05),而MAP和CPP均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组治疗后3个月、6个月格拉斯哥预后评分表(GCS)评分均明显高于对照组,差异有统计学意义(P<0.05)。观察组伤后6个月病死率和并发症发生率明显低于对照组,差异均有统计学意义(P<0.05)。结论:高渗钠溶液治疗闭合性颅脑外伤后颅内压增高,可以缓解患者脑水肿程度,降低颅内压水平,对改善患者预后具有重要意义。

高渗钠溶液复苏对烫伤犬肺损伤的防治作用

目的 探讨高渗钠溶液复苏对烫伤犬肺损伤的防治效果。 方法 采用犬 40 %TBSAⅢ度烫伤模型 ,随机分为高渗钠溶液组 (H组 )和等渗钠溶液组 (N组 ) ,每组 8只。分别于伤后 48h内检测心输出量 (CO)、心脏指数 (CI)、肺动脉压 (PAP)和肺血管阻力 (PVR)的变化 ,并留取肺组织检测肺含水量和烃类物质 (C2 H4 和C2 H6)含量 ,收集支气管肺泡灌洗液 (BALF)进行白细胞计数与分类 ,检测BALF中PLA2 活性和LTC4 含量变化。 结果 H组犬CO、CI值在伤后 48h显著高于N组 (P <0 .0 5 ) ,肺含水量、烃类物质 (C2 H4 和C2 H6)含量以及BALF中白细胞数、PLA2 活性和LTC4 含量显著低于N组 (P <0 .0 5～ 0 .0 1)。 结论 高渗钠溶液复苏有助于纠正烧伤早期肺损伤。

高渗钠溶液复苏可伴发肾功能衰竭和死亡

长期以来应用等渗盐溶液,主要为乳酸林格液,以复苏烧伤病人,Moyer提出复苏液中钠负荷较液体容量更为重要,应用250mmol/L钠浓度的溶液可在24小时内使低容量液体获得有效的生理性复苏,但有的作者执不同的意见.为此作者进行了下列临床实验;（1）LR1组:取1988～1991年109例烧伤病人用含130mmol/L钠的乳酸林格液复苏;（2）HSS组:取1991～1993年65例烧伤病人用含290mmol/L钠的高渗盐溶液复苏;（3）LR2组:取1993～1994年39例再用乳酸林格液复苏.HSS组和LR1组病人比较:年龄,46.0岁/43.6岁;烧伤总面积,39.2%/39.9%;吸入性灼伤,41.5%/47.7%.两组病人有可比性.

Hypertonic saline resuscitation reduces apoptosis of intestinal mucosa in a rat model of hemorrhagic shock

Objective: To investigate the early effects of hypertonic and isotonic saline solutions on apoptosis of intestinal mucosa in rats with hemorrhagic shock. Methods: A model of rat with severe hemorrhagic shock was established in 21 Sprague-Dawley (SD) rats. The rats were randomly divided into the sham group, normal saline resuscitation (NS) group, and hypertonic saline resuscitation (HTS) group, with 7 in each group. We detected and compared the apoptosis in small intestinal mucosa of rats after hemorrhagic shock and resuscitation by terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL), FITC (fluo- rescein-iso-thiocyanate)-Annexin V/PI (propidium iodide) double staining method, and flow cytometry. Results: In the early stage of hemorrhagic shock and resuscitation, marked apoptosis of small intestinal mucosa in the rats of both NS and HTS groups was observed. The numbers of apoptotic cells in these two groups were significantly greater than that in the sham group (P<0.01). In the HTS group, the apoptic cells significantly decreased, compared with the NS group (P<0.01). Conclusion: In this rat model of severe hemorrhagic shock, the HTS resuscitation of small volume is more effective than the NS resuscitation in reducing apoptosis of intestinal mucosa in rats, which may improve the prognosis of trauma.