各种浓度高渗盐水对重型颅脑外伤患者的临床研究

目的探讨不同浓度高渗盐水在重型颅脑外伤后脑水肿患者中的临床应用效果。方法选择我院120例患者．按照随机数字表法分为四组，每组各30例，四组高渗盐水浓度分别为23．4％、10％、7．5％、3％，监测平均动脉压、颅内压、电解质、血糖和尿素氮，并计算大脑灌注压和血浆渗透压。结果7．5％HS（高渗盐水）组颅内压降低幅度大于其他三组（P〈0．05），7．5％HS组平均动脉压及脑灌注压均高于其他三组，而颅内压低、钠离子、氯离子和血浆渗透压均低于其他三组（均P〈0．05）。结论不同浓度的高渗盐水对脑外伤后脑水肿患者颅内压、脑灌注压方面的影响差异较大．其中以7．5％HS效果最佳。短期内输注7．5％的高渗盐水对血钠浓度以及血浆晶体渗透压影响更小。

Clinical study on different concentrations hypertonic saline for patients with severe traumatic brain injury

Objective To study the security and effectiveness of different concentrations hypertonic saline for patients with brain edema after severe traumatic brain injury.Methods 120 patients in our hospital were divided into four groups according to random number table,10 cases was in each group,the hypertonic saline concentration of four groups were respectively 23.4%,10%,7.5%,3%,then the mean arterial pressure,intracranial pressure,electrolyte,blood glucose and urea nitrogen were monitored,and the perfusion pressure of brain and plasma osmotic pressure were calculated.Results The decreased degree of intracranial pressure of 7.5% HS(hypertonic saline) group was bigger than those of other three groups(P < 0.05),mean arterial pressure of 7.5% HS group was higher than those of other three groups(P < 0.05),the intracranial pressure of 7.5% HS group was lower than those of other three groups(P < 0.05),the brain perfusion pressure of of 7.5% HS group was higher than those of other three groups(P < 0.05),sodiumions and chlorideions of 7.5% HS group was lower than those of other three groups(P < 0.05),plasma osmotic pressure of 7.5% HS group was lower than those of other three groups(P < 0.05).Conclusion The four concentrations hypertonic saline all play important role in decreasing intracranial pressure and increasing brain perfusion pressureof patients with brain edema after severe traumatic brain injury,the effect of 7.5% HS is best,the influence of 7.5% hypertonic saline infusion in a short time for blood sodium concentration and plasma crystal osmotic pressure is smaller.