高渗氯化钠羟乙基淀粉40注射液对创伤性脑损伤疗效的观察

目的:观察高渗氯化钠羟乙基淀粉40(HSH40)注射液治疗创伤性脑损伤脑水肿的疗效及安全性。方法:将64例颅脑损伤患者随机分为试验组和对照组(各32例),在综合治疗基础上分别予HSH40和20%甘露醇治疗。检测两组颅内压(ICP)、血浆渗透压、平均动脉压(MAP)、脑灌注压(CPP)、血清Na+浓度、肾功能等指标。结果:与给药前相比较,两组给药后ICP均明显下降(P<0.05),但对照组总的下降水平低于试验组,回升速度也大于试验组,于60 m in时对照组ICP即明显高于试验组,两者差异有统计学意义(P<0.05)。给药后试验组各时间点CPP均高于给药前,并高于对照组同时间点(P<0.05);而对照组与给药前相比无显著性升高,差异无统计学意义(P>0.05)。给药后试验组各时间点血清Na+浓度均高于给药前,并高于对照组同时间点(P<0.05);而对照组较给药前无显著性升高,差异无统计学意义(P>0.05)。两组各时间点血浆渗透压均明显升高,高于给药前(P<0.05)。结论:HSH40治疗创伤性脑损伤后脑水肿效果确切且较为安全,降低ICP效果优于20%甘露醇,能较长时间维持ICP于较低水平,并可同时提高CPP,且肾功能损害等毒副作用轻。

Clinical observation of hypertonic sodium chloride hydroxyethyl starch 40 injection in treating traumatic brain injury

Objective:To observe the effects and safety of hypertonic sodium chloride hydroxyethyl starch 40 injection(HSH40) on brain edema induced by traumatic brain injury.Methods:64 patients diagnosed as traumatic brain injury(TBI) were randomly divided into two groups,both were taken combined treatment.The treatment group(n=32) was treated with HSH40 plus combined therapy;the control group(n=32) was treated with 20% mannitol.Intracranial pressure(ICP),plasma osmotic pressure,mean arterial pressure(MAP),cerebral perfusion pressure(CPP),serum Na+concentrations,renal function were monitored.Results:ICP decreased significantly in the two groups after the administration,but the augment of ICP decreased in the control group was lower than the treatment group(P<0.05).Upswing of ICP decreased in the control group was also faster and its quantitative value was significantly higher than the treatment group at 60 min(P<0.05).CPP increased significantly in the treatment groups after the administration in comparison with prior administration and the control group at all times(P<0.05).CCP did not significantly increase in the control group(P>0.05).Serum Na+concentrations increased significantly in the treatment group after administration in comparison with prior administration and the control group at all times(P<0.05).Serum Na+concentrations did not significantly increase in the control group(P>0.05).Plasma osmotic pressure increased significantly in two groups after the administration(P<0.05).Conclusions:HSH40 can be used safely and effectively to reduce ICP and relieve brain edema induced by traumatic brain injury and it is more effective than 20% mannitol.It maintains ICP at a lower level in a prolonged time and raises CPP at the same time without severe renal impairment.