高渗盐水治疗重型颅脑损伤并颅内高压效果分析被引量：3

Analysis of Effect of Hypertonic Saline in Treatment of Severe Craniocerebral Injury and Intracranial Hypertension

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摘要目的对比分析严重创伤性颅脑损伤后高渗盐水和甘露醇在降低每日的和累积的颅内压负荷的效果。方法回顾性分析第四军医大学唐都医院2009年1月—2014年12月间年龄在16岁以上遭受严重的创伤性颅脑损伤且住院治疗至少5 d的456例患者临床资料,其中36例患者仅接受高渗盐水治疗,102例患者仅接受甘露醇治疗,从102例患者中选择36例基本特征与高渗盐水组相似的36例患者与甘露醇组进行比较,比较每日的颅内压负荷和累积的颅内压负荷。结果在高渗盐水组累积的ICP负荷明显低于甘露醇组累积的ICP负荷[(15.6±19.5)/(36.9±31.5)%,P=0.001]。高渗盐水组每日的ICP负荷明显低于甘露醇组每日的ICP负荷[(0.3±0.7)/(1.4±1.2)h/d,P=0.001]。但累积的平均高渗盐水的剂量范围和甘露醇的剂量范围差异无统计学意义(1 089~3 300 m Osm/548~1100 m Osm,P=0.21)。高渗盐水组患者在ICU住院天数显著低于甘露醇组在ICU的住院天数[(8.3±2.3)/(9.5±0.8)d,P=0.004]。两周内的死亡率高渗盐水组低于甘露醇组,但差异无统计学意义。结论在严重创伤性颅脑损伤后高渗盐水比甘露醇能更有效的降低累积的和每日的ICP负荷。 Objective To compare and analyze the hypertonic saline in treatment of severe craniocerebral injury and intracranial hypertension. Methods 4 5 6 cases of severe craniocerebral injury patients whose length of stay was 5 days at least aged more than 16 years from January 2009 to December 2014 were selected including 36 cases of patients on-ly receiving the hypertonic saline and 102 cases only receiving the mannitol, 36 cases of them were selected, and the daily intracranial pressure load and cumulative intracranial pressure load were compared between the two groups. Re-sults The cumulative ICP load in the hypertonic saline group was obviously lower than that in the mannitol group （15.6±19.5） / （36.9±31.5）% , P=0 .0 0 1 , and the daily ICP load in the hypertonic saline group was obviously lower than that in the mannitol group, and the daily ICP load （0.3±0.7） / （1.4±1.2）h/d, P=0.001 , but the difference in the cumula-tive average hypertonic saline dose range and mannitol dose range was not statistically significant（1 089？3 300 mOsm/ 548-1 100 mOsm, P = 0 .2 1 ） , and the ICU length of stay in the hypertonic saline group was obviously lower than that in the mannitol group （8.3±2.3）d vs （9.5±0.8）d, P=0.004 , and the death rate within two weeks in the hypertonic salinegroup was lower than that in the mannitol group but the difference was not statistically significant. Conclusion Hyper-tonic saline in treatment of severe craniocerebral injurycan more effectively reduce the cumulative and daily ICP load.