等渗透剂量的7.5%高渗盐水和20%甘露醇治疗颅内高压疗效的对比研究

目的:比较等渗透剂量的7.5%高渗盐水(hypertonic saline,HTS)和20%甘露醇治疗颅高压的疗效。方法:当患者的颅内压(intracranial pressure,ICP)超过20 mm Hg时,一组患者接受了4 m L/kg 7.5%HTS(HTS组,n=27),另外一组患者接受了0.5 g/kg 20%甘露醇(甘露醇组,n=31)的降颅压治疗,两种药物均经深静脉在30 min内快速滴注完成。用药期间,连续监测患者ICP,平均动脉压(mean arterial pressure,MAP)、脑灌注压(cerebral perfusion pressure,CPP)及中心静脉压(central venous pressure,CVP)。记录有效降颅压持续时间、ICP最大降幅及其时间,用药前及用药后1 h、3 h、6 h抽血查电解质和血浆渗透压等。结果:静脉快速滴注7.5%HTS和20%甘露醇后,两者均可有效降低ICP(P0.05)。两组在控制颅高压的有效率、起效时间及ICP降幅无统计学差异(P0.05),但HTS组的作用持续时间要明显长于甘露醇组(P0.05)。两组渗透压较用药前相比均有显著上升(P0.05)。用药前后,两组MAP、CPP和CVP变化无统计学差异(P0.05)。结论:等渗透剂量的7.5%HTS与20%甘露醇均可有效降低患者的ICP,两者降颅压效果相当,均可作为治疗颅内高压的一线治疗药物。

Comparison of 7.5%Hypertonic Saline and 20%Mannitol in Doses of Similar Osmotic Burden for Treatment with Intracranial Hypertension

Objective:To compare the effects of 7.5 %hypertonic saline and 20 %mannitol in doses of similar osmotic burden for treating intracranial hypertension.Methods:A study was conducted with patients showing intracranial pressure (ICP) > 20 mmHg lasting for 5 min. Patients were administered either 4 mL/kg 7.5 %hypertonic saline (HTS group, n = 27) or 0.5 g/kg 20 %mannitol (mannitol group, n=31), intravenously from admission. Two agents were administered as a bolus via a central venous catheter, infused for over 30 min. Data collected fromeach eligible patient included ICP, plasma osmolarity, electrolytes, and potential adverse effects associated with HTS and mannitol during administration.Results:Both agents were effective in achieving goal ICP (ICP < 20 mmHg) during infusion. There were no statistical difference between both groups in the effective rate to control intracranial hypertension, biggest drop in ICP and the mean duration of the effect (P>0.05). Plasma osmolarity in two groups increased significantly (P<0.05).Conclusion:Treatment with 7.5 % HTS and 20 % mannitol in doses of similar osmotic burden produces is effective and safe for ICP control. Both agents can be recommended as first-line agents in management of raised ICP.