马卫华

【摘要】 目的 分析高渗盐水联合甘露醇治疗重型颅脑损伤后颅内压增高的效果。方法 116例重型颅脑损伤后颅内压增高患者， 按照就诊时间分为对照组和治疗组， 各58例。对照组应用甘露醇治疗， 治疗组应用高渗盐水联合甘露醇治疗。比较两组患者药物起效时间以及药物持续作用时间;用药前后颅内压水平;治疗前后脑灌注压以及平均动脉压水平。结果 两组患者药物起效时间比较差异无统计学意义（P>0.05）;治疗组药物持续作用时间（14.02±2.78）h长于对照组的（6.26±1.15）h， 差异有统计学意义（P<0.05）。治疗组用药1 h、3 h后颅内压水平分别为（17.32±1.77）、（14.52±1.06）mm Hg（1 mm Hg=0.133 kPa）， 均低于对照组的（21.32±2.27）、（18.73±2.14）mm Hg， 差异均有统计学意义（P<0.05）。治疗后， 治疗组脑灌注压（70.04±18.25）mm Hg、平均动脉压（104.2±10.24）mm Hg均高于对照组的（62.11±13.67）、（90.22±8.21）mm Hg， 差異均有统计学意义（P<0.05）。结论 重型颅脑损伤后颅内压增高选择高渗盐水联合甘露醇治疗可获得最短的药物起效时间和最长的作用时间， 帮助患者改善颅内压， 促进脑灌注恢复， 是预后的保障。

【关键词】 重型颅脑损伤;颅内压增高;甘露醇;高渗盐水

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.