地塞米松和甘露醇合用对急性重症脑血管病脑保护作用的疗效分析

目的:探讨地塞米松(DXM)和甘露醇合用对急性重症脑血管病脑保护作用的疗效。方法:将符合诊断条件的患者分为治疗组和对照组,治疗组在予甘露醇等脱水、降颅压、保护脑细胞等常规治疗的同时,在20%甘露醇中加入DXM 3 mg,每4～6 h静脉滴注1次,DXM 3 d后逐渐减量,持续应用3～5 d,最长不超过7 d;对照组只行常规治疗,同时对所有入选者每小时监测1次颅内压(ICP),持续监测到ICP恢复正常或死亡为止,并且分别在第1、3、6个月跟踪问卷调查,再次进行GCS评分。结果:入院时2组患者ICP比较差异无统计学意义(P0.05)。治疗后,治疗组ICP恢复正常多集中在2～4 d,而对照组多集中在3～7 d,第3、4天ICP恢复正常例数比较差异有统计学意义(P0.01)。2组并发症比较差异均无统计学意义(P0.05)。2组急性期共死亡10例,治疗组3例,病死率6%;对照组7例,病死率14%,差异无统计学意义(P0.05)。3次跟踪问卷调查并进行GCS评分,治疗组症状好转例数较对照组多(P0.05),新增死亡7例中,治疗组3例。结论:在脑血管病中,DXM和甘露醇合用对减轻脑水肿、降低颅内压和促进神经功能恢复的脑保护作用更强,且不增加其并发症和病死率。

Clinical study of the effect of dexamethasone with mannitol on acute severe cerebrovascular disease

Objective:To investigate the protective effect of dexamethasone(DXM) with mannitol on acute severe cerebrovascular disease.Methods:Patients met the diagnostic criteria were divided into treatment group and control group.In the treatment group,3 mg DXM 20% mannitol was given intravenously per 4-6 hours,continuous application of 3-5 days,a maximum of 7 days on the basis of routine treatment.The control group only received routine treatment.At the same time monitoring intracranial pressure(ICP) was monitered once per hour,until ICP returned to normal or the patients died.Then tracked them after the first survey at 1,3,6 months respectively,made GCS score again.Results:There was no significant difference in ICP on admission between the two groups(P>0.05).In the treatment group,ICP returned to normal in 2-4 days,but in the control group,more concentrated 3-7 days.Compared the number of cases,ICP returned to normal at the 3,4 days,the difference was statistically significant(P<0.01).The complications between the two goups showed no statistically significance(P>0.05).Ten cases were died in the acute phase in the two groups,the treatment group had 3 cases,mortality rate was 6%.The control group had 7 cases,mortality rate was 14%.In the treatment group,the number of cases with symptoms improved was more than the control group(P<0.05) in GCS score.The treatment group had 3 cases in 7 new deaths.Conclusions:DXM with mannitol can reduce more brain edema,more intracranial pressure and promote the recovery of neurological function than control group in acute cerebrovascular disease,and does not increase the morbidity and mortality.