目的:评价高渗盐水和甘露醇降低重型颅脑创伤患者颅内压(ICP)的效果.方法:我院治疗的重型颅脑损伤患者132例,随机分为高渗盐水组65例和甘露醇组67例,在常规治疗基础上,分别给予3％高渗盐水5.4 mL/kg和20％甘露醇5.0 mL/kg静脉滴注.评价2组治疗期间的药物起效时间、最大ICP下降幅度、累积颅内压负荷(CICPB)、平均ICP负荷时间、压力累及时间(PTD)、ICU停留时间和格拉斯哥预后评分(GOS).结果:2组起效时间、最大ICP下降幅度组间比较差异无统计学意义(P＞0.05);高渗盐水组PTD、CICPB和ICP负荷时间均小于甘露醇组(P＜0.05);2组ICU停留时间、GOS评分和临床预后差异无统计学意义(P＞0.05).以GOS评分为因变量的多元线性回归分析结果显示,PTD、CICPB、ICP负荷时间与GOS呈负相关(P＜0.05),起效时间、最大ICP下降幅度与GOS不相关(P＞0.05).结论:高渗盐水稳定重型颅脑损伤患者ICP的效果优于甘露醇,但不能改善临床预后.%Objective:To evaluate the difference of clinical efficacy between hypertonic saline and mannitol in reducing intracranial pressure (ICP) in patients with severe traumatic brain injury.Methods:One hundred and thirty-two patients with severe traumatic brain injury were randomly divided into hypertonic saline group (n=65) and mannitol group (n=67).In addition to regular therapy for severe traumatic brain injury,the cases in the hypertonic saline group were treated with 3％ hypertonic saline 5.4 mL/kg and those in the mannitol group were treated with 20％ mannitol 5.0 ml/kg respectively.Indexes including onset time,maximum descend range of ICP,cumulative ICP burden (CICPB),average ICP load time,time pressure involved (PTD),ICU stay duration and Glasgow outcome scale (GOS) were evaluated after the treatment.Results:There was no significant differences in onset time,maximum descend range of ICP between the 2 groups (P＞0.05).PTD,CICPB and ICP load time in the hypertonic saline group were less than those in the mannitol group (P＜0.05).There was no siginificant differences in ICU stay,GOS score and clinical prognosis between the two groups (P＞0.05).Multiple regression analysis with GOS score as a dependent variable showed that PTD,CICPB and ICP load time were negatively correlated with GOS (P＜0.05),and onset time,maximum ICP decrease had no relation with GOS (P＞0.05).Conclusion:Hypertonic saline was better than mannitol in reducing ICP in patients with severe traumatic brain injury.However,the method could not significantly improve clinical outcomes of patients.
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