半量甘露醇和甘油果糖序贯治疗高血压脑出血后脑水肿的临床疗效

摘要

Objective:To analyze and discuss the clinical effect of sequential therapy with half-dose of mannitol and glycerol-fructose in the treatment of brain edema after intracerebral hemorrhage.Method:A total of 80 patients with brain edema after intracerebral hemorrhage in our hospital from January 2013 to January 2015 were equally divided into observation group and control group,40 cases in each group.Patients in observation were given half-dose of 20% mannitol (125 mL) and glycerine-fructose, while patients in control group were given full dose of 20% mannitol (250 mL) and glycerine-fructose.Intracranial pressure, area of the brain edema, index of hemorheology,scores of GCS and NIHSS of two groups were compared.At the same time,the rates of abnormal renal function and disturbance of water and electrolyte of two groups were compared.Result:The rates of abnormal renal function and disturbance of water and electrolyte in observation group were respectively 7.50% and 2.50%,those in control group were respectively 27.50% and 22.50%,the differences were statistically significant (P<0.05).Conclusion:Half-dose of mannitol combined with glycerine-fructose has similar clinical effect compares with full dose of mannitol combined with glycerine-fructose on sequentially treating brain edema after intracerebral hemorrhage,both of those two methods have advantage in improving intracranial pressure,blood flow of head and neurological function,but the half-dose of mannitol has lesser impacts in renal function and water electrolyte balance,so as it is more safer.%目的：分析探讨半量甘露醇联合甘油果糖序贯治疗高血压脑出血后脑水肿的临床效果。方法：将本院在2013年1月-2015年1月期间收治的80例高血压脑出血后脑水肿患者随机分为观察组和对照组，每组各40例。观察组患者采用半量（125 mL）20%甘露醇联合甘油果糖序贯治疗，对照组患者采用全量（250 mL）20%甘露醇联合甘油果糖序贯治疗。观察两组患者治疗前后颅内压控制以及格拉斯哥昏迷评分（GCS）和神经功能缺损评分（NIHSS）变化，比较两组患者肾功能以及血电解质的变化情况。结果：观察组肾功能异常和水电解质异常发生率分别为7.50%和2.50%，对照组肾功能异常和水电解质异常发生率分别为27.50%和22.50%，观察组均低于对照组，两组比较差异均有统计学意义（P<0.05）。结论：半量甘露醇与全量甘露醇联合甘油果糖序贯治疗高血压脑出血后脑水肿疗效相似，均能明显改善患者的颅内压、头部血流和神经功能，但半量甘露醇对患者肾功能和血电解质平衡影响较小，因此安全性更高。