甘露醇治疗脑外伤致急性肾损伤及阿魏酸钠的治疗作用研究

摘要

目的：研究甘露醇治疗脑外伤引发的急性肾损伤（AKI）及阿魏酸钠对此的治疗作用。方法选择2010年8月至2014年2月医院需要使用甘露醇治疗的脑外伤患者256例，随机分为两组，高剂量组给予甘露醇150~200 g/d，低剂量组给予75~150 g/d，连续7 d，观察肾功能指标的变化。将发生急性肾功能损害的患者再随机分为两组，在常规对症治疗（常规对照组）基础上，阿魏酸钠组加用阿魏酸钠30 mg静脉滴注，连续10 d，观察AKI的发生率及治疗总有效率。结果在甘露醇治疗过程中，高剂量组AKI发生率为49.22%，明显高于低剂量组的24.22%（ P﹤0.05）；AKI患者经对症治疗后肌酐、尿素及胱抑素C水平均较治疗前明显下降（ P﹤0.05），且阿魏酸钠组较常规对照组下降更明显（ P ﹤0.05）；AKI 患者的治疗总有效率均较高，阿魏酸钠组为97.87%，高于常规对照组的91.49%（ P﹤0.05）；甘露醇高剂量组不良反应发生率为13.28%，明显高于低剂量组的3.13%（ P﹤0.05），而在AKI治疗过程中未发现明显不良反应。结论高剂量甘露醇治疗脑外伤致AIK及其他不良反应的发生率明显高于低剂量甘露醇，阿魏酸钠联合常规治疗能提高AIK的治疗总有效率，改善脑外伤患者预后，且无明显不良反应，值得临床推广。%Objective To conduct the research on mannitol for treating acute kidney injury(AKI)caused brain trauma and the therapeutic effect of sodium ferulate. Methods 256 patients with brain trauma needing the mannitol treatment admitted to our hospital from August 2010 to February 2014 were selected and randomly divided into the two groups. The high dose group was given mannitol 150-200 g/d and the low dose group was given mannitol 75-150 g/d for consecutive 7 d. The changes of the renal function was observed. The pa-tients with renal injury were randomly redivided into 2 groups. On the basis of the conventional therapy,the sodium ferulate group was added with sodium ferulate 30 mg by intravenous drip for consecutive 10 d. The occurrence rate of AKI and the total curative effective rate were observed. Results The occurrence rate of AKI during the mannitol treatment process in the high dose group was 49. 22%, which was significantly higher than 24. 22% in the low-dose group( P ﹤ 0. 05);the levels of creatinine,urea,and cystatin C after symptomatic treatment in the patients with AKI were significantly decreased compared with before treatment( P ﹤ 0. 05),moreover the decrease in the sodium ferulate group was more significantly than that in the conventional control group( P ﹤ 0. 05);the total ther-apeutically effective rate of the AKI patients was higher,which was 97. 87% in the sodium ferulate group and 91. 49% in the con-ventional control group,the sodium ferulate group was significantly higher than the conventional control group( P ﹤ 0. 05);the occur-rence rate of adverse reactions in the high-dose group was 13. 28%,which was significantly higher than 3. 13% in the low dose group( P ﹤ 0. 05),bue no obvious adverse reactions were found during the AKI treatment process. Conclusion The high dose of man-nitol for treating brain trauma has the higher occurrence rate of AKI and other adverse reactions than the low dose mannitol,the com-bination therapy of ferulic sodium and conventional treatment could increase the total effective rate of AKI and improve the prognosis of the patients with brain trauma without obvious adverse reactions,which is worthy of clinical promotion.