高渗盐复合液治疗急性颅内高压伴失血性休克患者的临床观察

摘要

Objective To observe the effect of hypertonic saline complex solution (hypertonic saline plus hydroxyethyl starch,HSH) on patients with severe cerebral trauma,high intracranial pressure and shock by the measurement of the changes of the mean arterial pressure (MAP),central venous pressure (CVP) and intracranial pressure (ICP),as well as GOS score changes followed up for 6 months,in order to determine the value of HSH treatment in severe cerebral trauma,intracranial hypertension and shock.Methods Sixty patients with severe brain injury and uncorrected hemorrhagic shock were selected,while the degree of coma was assessed by using GCS score,and shock severity was estimated by using the shock index (SI) score.The patients were randomly divided into HSH group (n =30) and mannitol group (MT group,n =30).Thirty minutes,60 min and 120 min after administration either solution,The changes of MAP,CVP and ICP were observed in two groups,and all patients were followed up for 6 months to observe the outcomes of patients.Results There were no statistically significant differences in age,gender,GCS score,SI scores,and other medication between two groups (P ＞ 0.05),and they were comparable between two groups.After resuscitation of patients in two groups,MAP and CVP were elevated,but the effect of HSH appeared sooner and higher within 30 minutes [MAP (63.1 ± 8.8) mmHg vs.(51.0-9.3) mmHg] (P ＜ 0.05);At the same time,ICP dropped more than 10％ lower [ICP (27.3 ± 5.9) mmHg vs.(32.8 ± 4.1) mmHg] (P ＜0.05),while the effect of MT appeared more slowly in hemodynamic improvement;at 120 min,the increase in MAP and reduction in ICP in HSH group were more significant than those in MT group [MAP (65.9 ± 13.2) mmHg vs.(60.4 ±7.2) mmHg] (P ＜0.01);the ICP [(22.2 ±4.7) mmHg vs.(28.1 ±6.1) mmHg] (P ＜ 0.01).Followed up for 6 months,good recovery rate in HSH group was higher and poor recovery rate was lower than those in MT group.Conclusions In patients with acute intracranial hypertension and uncorrected hemorrhagic shock,the employment of hypertonic saline plus hydroxyethyl starch solution can produce faster and more effective therapy for shock and reduce intracranial pressure,improving the long-term neurological function of patients.%目的 通过观察高渗盐复合液(HSH)对重型颅脑外伤颅内高压并失血性休克患者的平均动脉压(MAP)、中心静脉压(CVP)和颅内压(ICP)的变化,以及随访6个月预后GOS评分的变化,探讨HSH治疗重型颅脑外伤颅内高压并休克患者的临床疗效.方法 ①选择在上海市静安区闸北中心医院ICU及脑外科住院治疗的创伤重型颅脑损伤并失血性休克患者60例,病情评估昏迷程度按GCS评分,休克严重程度按休克指数(SI)评分;随机(随机数字法)分为高渗盐复合液组(HSH组)30例,甘露醇组(MT组)30例.②观察两组患者给药后30 min、60 min、120 min的MAP、CVP和ICP的变化,并随访6个月观察患者的预后.结果 ①两组患者的年龄、性别、GCS评分、SI评分及其他合并用药等方面差异均无统计学意义(P＞0.05),有可比性.②复苏后两组患者MAP及CVP均升高,但HSH组30 min内即见效[MAP (63.1±8.8)mmHgvs.(51.0±9.3)mmHg](P＜0.05);同时ICP降低10％以上[ICP (27.3±5.9) mmHgvs.(32.8±4.1) mmHg] (P＜0.05),而MT组较迟出现血流动力学改善;120 min时HSH组升高MAP和降低ICP的作用仍较MT组显著[MAP (65.9±13.2) mmHgvs.(60.4±7.2) mmHg] (P＜0.01);[ICP(22.2±4.7) mmHgvs.(28.1±6.1) mmHg] (P＜0.01).③随访6个月,HSH组恢复良好率优于MT组,恢复不良率低于MT组.④两组均未发生药物不良反应.结论 对于急性颅内高压伴失血性休克的患者,高渗盐复合液能更快更有效地纠正休克和降低颅内压,改善患者的长期预后.