中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
17期
7-10
,共4页
盛鹰%谢晓洪%蔡金芳%王静恩%高波
盛鷹%謝曉洪%蔡金芳%王靜恩%高波
성응%사효홍%채금방%왕정은%고파
盐水,高渗%颅脑损伤%甘露醇
鹽水,高滲%顱腦損傷%甘露醇
염수,고삼%로뇌손상%감로순
Saline solution,hypertonic%Craniocerebral trauma%Mannitol
目的 探讨3％高渗氯化钠(HS)在重型颅脑损伤术后患者中的应用.方法 将68例重型颅脑损伤术后患者按照随机数字表法分为HS组和对照组,每组34例,对照组20％甘露醇125 ml每6h或每8h1次,而HS组在常规甘露醇治疗的基础上加用3％ HS 130 ml,每8h或每12h 1次,与甘露醇交替使用,快速静脉滴注.分别于第1天6、12、24h内,第2天24h内,第3天24h内,第5天24h内统计颅内压(ICP)、平均动脉压(MAP)、中心静脉压(CVP).第1天12、24h内,第2天24h内,第3天24h内,第5天24h内统计血钠水平,计算血浆渗透浓度.第1天24h内、第3天24h内、第5天24h内统计格拉斯哥昏迷量表(GCS)评分.结果 HS组在各时间点ICP均小于对照组,差异有统计学意义(P＜0.05)；两组在第1、2天各时间点ICP变化趋势不明显(P＞0.05),但第3、5天24h内,两组ICP均较第1、2天各时间点明显上升(P＜0.05).HS组在第1天6、12、24h内和第2天24h内MAP和CVP分别为(87.98±5.03)、(88.56±5.36)、(87.04±6.90)、(90.03±5.19)mm Hg(1 mm Hg=0.133 kPa)和(9.23±1.24)、(9.67±1.35)、(10.21±1.38)、(10.56±1.96) mm Hg,均高于对照组的(77.98±5.09)、(79.98±6.09)、(80.98±5.27)、(81.98±4.32) mm Hg和(7.15±2.01)、(8.32±1.53)、(8.67±1.89)、(9.22±2.03) mm Hg,差异有统计学意义(P＜0.05),但第3、5天24h内两组比较差异无统计学意义(P＞0.05).HS组在各时间点血钠及血浆渗透浓度均高于对照组(P＜0.05).HS组第1、3、5天24h内GCS评分分别为(4.21±2.31)、(5.44±2.46)、(7.23±1.64)分,对照组分别为(4.14±2.10)、(5.15±2.31)、(7.31±2.12)分,两组第5天24h内GCS评分均明显高于第1天24h内(P＜0.05),但两组间比较差异无统计学意义(P＞ 0.05).结论 加用3％ HS可以更加有效地降低ICP,改善脑灌注,且不良反应少,可以作为重型颅脑损伤术后患者的一线用药.
目的 探討3％高滲氯化鈉(HS)在重型顱腦損傷術後患者中的應用.方法 將68例重型顱腦損傷術後患者按照隨機數字錶法分為HS組和對照組,每組34例,對照組20％甘露醇125 ml每6h或每8h1次,而HS組在常規甘露醇治療的基礎上加用3％ HS 130 ml,每8h或每12h 1次,與甘露醇交替使用,快速靜脈滴註.分彆于第1天6、12、24h內,第2天24h內,第3天24h內,第5天24h內統計顱內壓(ICP)、平均動脈壓(MAP)、中心靜脈壓(CVP).第1天12、24h內,第2天24h內,第3天24h內,第5天24h內統計血鈉水平,計算血漿滲透濃度.第1天24h內、第3天24h內、第5天24h內統計格拉斯哥昏迷量錶(GCS)評分.結果 HS組在各時間點ICP均小于對照組,差異有統計學意義(P＜0.05)；兩組在第1、2天各時間點ICP變化趨勢不明顯(P＞0.05),但第3、5天24h內,兩組ICP均較第1、2天各時間點明顯上升(P＜0.05).HS組在第1天6、12、24h內和第2天24h內MAP和CVP分彆為(87.98±5.03)、(88.56±5.36)、(87.04±6.90)、(90.03±5.19)mm Hg(1 mm Hg=0.133 kPa)和(9.23±1.24)、(9.67±1.35)、(10.21±1.38)、(10.56±1.96) mm Hg,均高于對照組的(77.98±5.09)、(79.98±6.09)、(80.98±5.27)、(81.98±4.32) mm Hg和(7.15±2.01)、(8.32±1.53)、(8.67±1.89)、(9.22±2.03) mm Hg,差異有統計學意義(P＜0.05),但第3、5天24h內兩組比較差異無統計學意義(P＞0.05).HS組在各時間點血鈉及血漿滲透濃度均高于對照組(P＜0.05).HS組第1、3、5天24h內GCS評分分彆為(4.21±2.31)、(5.44±2.46)、(7.23±1.64)分,對照組分彆為(4.14±2.10)、(5.15±2.31)、(7.31±2.12)分,兩組第5天24h內GCS評分均明顯高于第1天24h內(P＜0.05),但兩組間比較差異無統計學意義(P＞ 0.05).結論 加用3％ HS可以更加有效地降低ICP,改善腦灌註,且不良反應少,可以作為重型顱腦損傷術後患者的一線用藥.
목적 탐토3％고삼록화납(HS)재중형로뇌손상술후환자중적응용.방법 장68례중형로뇌손상술후환자안조수궤수자표법분위HS조화대조조,매조34례,대조조20％감로순125 ml매6h혹매8h1차,이HS조재상규감로순치료적기출상가용3％ HS 130 ml,매8h혹매12h 1차,여감로순교체사용,쾌속정맥적주.분별우제1천6、12、24h내,제2천24h내,제3천24h내,제5천24h내통계로내압(ICP)、평균동맥압(MAP)、중심정맥압(CVP).제1천12、24h내,제2천24h내,제3천24h내,제5천24h내통계혈납수평,계산혈장삼투농도.제1천24h내、제3천24h내、제5천24h내통계격랍사가혼미량표(GCS)평분.결과 HS조재각시간점ICP균소우대조조,차이유통계학의의(P＜0.05)；량조재제1、2천각시간점ICP변화추세불명현(P＞0.05),단제3、5천24h내,량조ICP균교제1、2천각시간점명현상승(P＜0.05).HS조재제1천6、12、24h내화제2천24h내MAP화CVP분별위(87.98±5.03)、(88.56±5.36)、(87.04±6.90)、(90.03±5.19)mm Hg(1 mm Hg=0.133 kPa)화(9.23±1.24)、(9.67±1.35)、(10.21±1.38)、(10.56±1.96) mm Hg,균고우대조조적(77.98±5.09)、(79.98±6.09)、(80.98±5.27)、(81.98±4.32) mm Hg화(7.15±2.01)、(8.32±1.53)、(8.67±1.89)、(9.22±2.03) mm Hg,차이유통계학의의(P＜0.05),단제3、5천24h내량조비교차이무통계학의의(P＞0.05).HS조재각시간점혈납급혈장삼투농도균고우대조조(P＜0.05).HS조제1、3、5천24h내GCS평분분별위(4.21±2.31)、(5.44±2.46)、(7.23±1.64)분,대조조분별위(4.14±2.10)、(5.15±2.31)、(7.31±2.12)분,량조제5천24h내GCS평분균명현고우제1천24h내(P＜0.05),단량조간비교차이무통계학의의(P＞ 0.05).결론 가용3％ HS가이경가유효지강저ICP,개선뇌관주,차불량반응소,가이작위중형로뇌손상술후환자적일선용약.
Objective To study the application of 3％ hypertonic saline (HS) in patients with severe craniocerebral injury after operation.Methods Sixty-eight cases with severe craniocerebral injury after operation were divided by random digits table method into HS group and control group with 34 cases each.The patients in control group were treated with 125 ml 20％ mannitol every 6 hours or 8 hours.The patients in HS group were given conventional mannitol and added with 130 ml 3％ HS every 12 hours or 8 hours through fast intravenous drip altemated with mannitol.The levels of intracranial pressure (ICP),mean arterial pressure (MAP),central venous pressure (CVP) were recorded within 6 hours,12 hours,24 hours of the 1st day,24 hours of the 2nd day,24 hours of the 3rd day,24 hours of the 5th day.The Na+ level of blood serum and the plasma osmotic pressure were recorded and calculated within 12 hours,24 hours of the 1st day,24 hours of the 2nd day,24 hours of the 3rd day,24 hours of the 5th day.The Glasgow coma scale( CCS) score was accounted within 24 hours of the 1 st day,24 hours of the 3rd day,24 hours of the 5th day.Results Compared with control group,the level of ICP in HS group decreased at every time point (P ＜ 0.05).The tendency of ICP in two groups was not significant on the 1st and 2rid day (P ＞ 0.05 ),but the level of ICP within 24 hours of the 3rd and 5th day obviously increased compared with those of the 1st and 2nd day (P＜0.05).The levels of MAP and CVP in HS group were significantly higher than those in control group within 6 hours,12 hours and 24 hours of the 1 st day and 24 hours of the 2nd day [ ( 87.98 ± 5.03 ),(88.56 ± 5.36),(87.04 ±6.90),(90.03 ±5.19) mm Hg (1 mm Hg =0.133 kPa) vs.(77.98 ±5.09),(79.98 ±6.09),(80.98 ± 5.27),(81.98 ± 4.32) mm Hg and (9.23 ± 1.24),(9.67 ± 1.35),( 10.21 ± 1.38 ),( 10.56 ± 1.96)mm Hg vs.(7.15 ± 2.01 ),(8.32 ± 1.53),(8.67 ± 1.89),(9.22 ± 2.03) mm Hg] (P ＜ 0.05),but the values within 24 hours of the 3rd and 5th day between two groups had no significant differences (P＞ 0.05 ).The Na+ level of blood serum and the plasma osmotic pressure in HS group at every time point was obviously higher than that in control group (P＜ 0.05).The GCS scores within 24 hours of the 1st,3rd and 5th day in HS group were (4.21 ± 2.31 ),(5.44 ± 2.46 ),(7.23 ± 1.64 ) scores,respectively,while the scores in control group were (4.14 ± 2.10),(5.15 ± 2.31 ),(7.31 ± 2.12) scores,respectively ;the score within 24 hours of the 5th day in two groups was obviously higher than that of the 1st day respectively (P＜ 0.05 ),but the scores between two groups had no statistical significance (P＞ 0.05 ).Conclusions Adding 3％ HS is more effective to decrease ICP,improve the brain perfusion and reduce the adverse reactions.3％ HS can be used as the first-line therapy for patients with severe craniocerebral injury after operation.
