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目的 以甘露醇作对比 ,探讨用 2 3 4 %高渗盐水治疗颅内高压的效果和副作用。方法 对 15名昏迷的、有侧脑室引流指征的脑出血患者进行共 5 2例次降颅内压治疗。随机决定静脉推注 2 3 4 %高渗盐水 30ml,或静滴 2 0 %甘露醇 2 5 0ml。用药前至用药后 6h内 ,持续监测颅内压 (ICP)、平均动脉压 (MAP)、中心静脉压 (CVP)、脑灌注压 (CPP)、血生化和渗透压。结果 用药后 (2 8± 2 0 )min ,高渗盐水使ICP下降 (2 5± 1 1)kPa (P <0 0 1) ,可持续 3h有效降颅压 ,并可使MAP下降 ;甘露醇在用药后 (4 9± 2 5 )min内 ,使ICP下降 (2 0± 1 3)kPa (P <0 0 1) ,可持续 1h有效降颅压 ,并明显利尿。 6h内两组的CVP、血生化以及渗透压无明显变化 (P >0 0 5 )。结论 2 3 4 %高渗盐水可有效治疗颅内高压 ,比 2 0 %甘露醇起效更快、更持久 ,效力相当 ,可考虑作为一线降颅内压药物。
Objective To compare the effect of mannitol on the treatment of intracranial hypertension with 2 3 4% hypertonic saline. Methods A total of 52 cases of intracranial pressure were treated in 15 comatose patients with ICH indications of lateral ventricle drainage. Randomly decided intravenous injection of 23.4% hypertonic saline 30ml, or intravenous infusion of 20% mannitol 250ml. The intracranial pressure (ICP), mean arterial pressure (MAP), central venous pressure (CVP), cerebral perfusion pressure (CPP), blood biochemistry and osmotic pressure were continuously monitored within 6 hours after treatment. Results After treated with 2,8 ± 20 min, hypertonic saline decreased ICP by 25 ± 1 1 kPa (P <0.01), effectively reduced intracranial pressure and decreased MAP at 3 hours, while mannitol ICP decreased by (20 ± 1 3) kPa (P <0.01) within 4 49 ± 2 5 min after treatment, and intracranial pressure was effectively reduced for 1 h, and obvious diuresis was observed. There was no significant change in CVP, blood biochemistry and osmotic pressure in both groups within 6h (P> 0.05). Conclusions 23.4% hypertonic saline can effectively treat intracranial hypertension, which has a faster and longer lasting effect than 20% mannitol and has equivalent efficacy. It can be considered as a first-line intracranial pressure lowering drug.