高滲鹽水聯合甘露醇治療重型顱腦損傷后顱內壓增高的效果觀察

馬衛華

【摘要】 目的 分析高滲鹽水聯合甘露醇治療重型顱腦損傷后顱內壓增高的效果。方法 116例重型顱腦損傷后顱內壓增高患者， 按照就診時間分為對照組和治療組， 各58例。對照組應用甘露醇治療， 治療組應用高滲鹽水聯合甘露醇治療。比較兩組患者藥物起效時間以及藥物持續作用時間;用藥前后顱內壓水平;治療前后腦灌注壓以及平均動脈壓水平。結果 兩組患者藥物起效時間比較差異無統計學意義（P>0.05）;治療組藥物持續作用時間（14.02±2.78）h長于對照組的（6.26±1.15）h， 差異有統計學意義（P<0.05）。治療組用藥1 h、3 h后顱內壓水平分別為（17.32±1.77）、（14.52±1.06）mm Hg（1 mm Hg=0.133 kPa）， 均低于對照組的（21.32±2.27）、（18.73±2.14）mm Hg， 差異均有統計學意義（P<0.05）。治療后， 治療組腦灌注壓（70.04±18.25）mm Hg、平均動脈壓（104.2±10.24）mm Hg均高于對照組的（62.11±13.67）、（90.22±8.21）mm Hg， 差異均有統計學意義（P<0.05）。結論 重型顱腦損傷后顱內壓增高選擇高滲鹽水聯合甘露醇治療可獲得最短的藥物起效時間和最長的作用時間， 幫助患者改善顱內壓， 促進腦灌注恢復， 是預后的保障。

【關鍵詞】 重型顱腦損傷;顱內壓增高;甘露醇;高滲鹽水

DOI：10.14163/j.cnki.11-5547/r.2020.10.003

【Abstract】 Objective ? To analyze the effect of hypertonic saline combined with mannitol on the increase of intracranial pressure after severe craniocerebral injury. Methods ? A total of 116 patients with increase of intracranial pressure after severe craniocerebral injury were divided into control group and treatment group by visit time， with 58 cases in each group. The control group was treated by mannitol， and the treatment group was treated by hypertonic saline combined with mannitol. The onset time， duration of drug action， and intracranial pressure before and after medication， cerebral perfusion pressure and mean arterial pressure before and after treatment were compared between the two groups. Results ? There was no statistically significant difference in onset time between the two groups （P>0.05）. The duration of drug action of the treatment group （14.02±2.78） h was longer than that of the control group （6.26±1.15） h， and the difference was statistically significant （P<0.05）. 1 and 3 h after medication， the intracranial pressure of the treatment group were （17.32±1.77） and （14.52±1.06） mm Hg?（1 mm Hg=0.133 kPa） respectively， which were all lower than those of the control group （21.32±2.27） and （18.73±2.14） mm Hg， and the difference was statistically significant （P<0.05）. After treatment， the cerebral perfusion pressure （70.04±18.25） mm Hg and mean arterial pressure （104.2±10.24） mm Hg of the treatment group were all higher than （62.11±13.67） and （90.22±8.21） mm Hg of the control group， and the difference was statistically significant （P<0.05）. Conclusion ? For increased intracranial pressure after severe craniocerebral injury， hypertonic saline combined with mannitol can obtain the shortest onset time and the longest action time to help patients improve intracranial pressure， promote the recovery of cerebral perfusion， and is the guarantee of prognosis.