陈春艳　刘小军　祁绍艳

【摘要】 目的 探究高渗盐水与甘露醇联合治疗对重型颅脑损伤颅内压增高患者血清肌酐（Scr）水平及格拉斯哥昏迷量表（GCS）评分的影响。方法 采用随机数字表，将2014年1月～2019年1月86例重型颅脑损伤颅内压增高患者分为两组，各43例。两组均予以常规治疗，对照组在常规治疗基础上予以20%甘露醇治疗，观察组在对照组基础上联合3%高渗盐水治疗，均治疗7 d。对比两组颅内压（ICP）、平均动脉压（MAP）、脑灌注压（CPP）、GCS评分及Scr水平。结果 治疗7 d后，观察组ICP、MAP及CPP均低于对照组，血清Scr水平低于对照组，差异有统计学意义（P<0.05），而GCS评分略高于对照组，但差异无统计学意义（P>0.05）。结论 高渗盐水与甘露醇联合治疗可降低重型颅脑损伤颅内压增高患者的ICP水平，且对血清Scr影响更小，但对GCS评分改善并不明显。

【关键词】 重型颅脑损伤;颅内压增高;甘露醇;高渗盐水;血清肌酐;格拉斯哥昏迷评分

中图分类号：R651.1+5   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.02.014

【Abstract】 Objective To investigate the effect of hypertonic saline combined with mannitol on serum creatinine （Scr） level and Glasgow coma scale （GCS） score in patients with increased intracranial pressure after severe head injury. Methods 86 patients with increased intracranial pressure after severe craniocerebral injury from January 2014 to January 2019 were divided into control group and observation group， with 43 cases in each group. Both groups were given routine treatment， the control group were treated with 20% mannitol on the basis of routine treatment， and the observation group were treated with 3% hypertonic saline on the basis of the control group. Both groups were treated for 7 days. And then， intracranial pressure （ICP）， mean arterial pressure （MAP）， cerebral perfusion pressure （CPP）， GCS score and Scr level were compared between the two groups. Results After 7 days of treatment， the ICP， MAP and CPP of the observation group were all lower than those of the control group， and serum Scr level was lower than that of the control group， and difference was statistically significant （P < 0.05）， while the GCS score was slightly higher than that of the control group， but difference was not statistically significant （P > 0.05）. Conclusion Hypertonic saline combined with mannitol can reduce ICP levels in patients with increased intracranial pressure after severe craniocerebral injury， it has less effect on serum Scr， but has no obvious improvement on GCS score.

【Key words】 severe craniocerebral injury; increased intracranial pressure; mannitol; hypertonic saline; Scr; GCS

重型顱脑损伤后颅内压（ICP）增高患者以意识障碍、感觉障碍和肢体瘫痪为主要临床表现，临床主要采用甘露醇进行脱水利尿治疗，但该药到达人体后1 h才发挥利尿作用。重型颅脑损伤后颅内压增高患者病情较为严重，单纯用甘露醇治疗对脑部水肿的改善效果并不理想，导致血清肌酐（Scr）浓度升高，造成肾损伤，对患者生命有较大的威胁[1～2]。而高渗盐水是由氯化钠和生理盐水配置而成的高效脱水药物，进入人体后起效快，且半衰期长[3]。基于此，本研究旨在探究高渗盐水与甘露醇联合对重型颅脑损伤颅内压增高患者血清Scr水平及格拉斯哥昏迷量表（GCS）评分的影响，报道如下。……