高渗盐液治疗急诊重度脑外伤并休克的效果

目的探讨高渗盐液治疗急诊重度脑外伤并休克的治疗效果。方法选取114例急诊重度脑外伤并休克患者,并按随机数字表法分为观察组63例,对照组51例。观察组和对照组治疗早期分别予7.5%高渗盐液和20%甘露醇溶液治疗。结果 2组降颅压效果均较明显,降颅压维持时间较好,维持平均动脉压基本不变,脑灌注压比较差异无统计学意义（P〉0.05）。治疗60 min时HR、治疗30和60 min时尿量的控制效果,观察组优于对照组（P〈0.05）。结论急诊重度脑外伤并休克患者的治疗过程中,应用高渗盐液治疗,具有较好的效果。     

高渗盐液在急诊重度脑外伤合并休克患者治疗中的效果

目的探讨高渗盐液在治疗急诊重度脑外伤合并休克患者中的效果。方法选取该院2017年5月至2018年5月收治的102例急诊重度脑外伤合并休克患者作为研究对象,根据治疗方法不同分为观察组和对照组,每组各51例。对照组患者给予林格氏液和甘露醇溶液进行治疗,观察组患者给予高渗盐液治疗,比较两组患者治疗效果并观察治疗前后格拉斯哥昏迷评分及治疗后尿量、颅内压、脑灌注压、平均动脉压水平。结果观察组患者治疗总有效率高于对照组,两组患者治疗后格拉斯哥昏迷评分较治疗前均升高,差异均有统计学意义(P<0.05),但治疗后两组间格拉斯哥昏迷评分比较,差异无统计学意义(P>0.05);观察组患者治疗后尿量、颅内压、平均动脉压水平均低于对照组,脑灌注压水平高于对照组,差异均有统计学意义(P<0.05)。结论急诊重度脑外伤合并休克患者接受高渗盐液治疗效果明显,可快速改善患者临床各指标及昏迷程度,临床实用价值较高。     

静脉快速滴注甘露醇与高渗盐液治疗急诊重度脑外伤并休克的疗效比较

目的比较静脉快速滴注甘露醇与高渗盐液治疗急诊重度脑外伤并休克的疗效。方法选取我院2017年2月～2019年2月收治的80例急诊重度脑外伤并休克患者,将采用静脉快速滴注甘露醇治疗的40例患者临床资料归为对照组,将采用静脉快速滴注高渗盐液治疗的40例患者临床资料归为观察组,比较两组患者不同时间段生命体征指标、尿量、睡眠质量及病情转归情况。结果治疗后30min、2h,观察组患者心率、呼吸频率均低于对照组,平均动脉压、尿量高于对照组,差异有统计学意义(P<0.05);治疗后24h、48h,观察组匹兹堡睡眠质量量表(PSQI)评分及死亡率低于对照组,差异有统计学意义(P<0.05)。结论与静脉快速滴注甘露醇比较,急诊重度脑外伤并休克患者采取静脉快速滴注高渗盐液治疗的效果显著,能有效的改善患者生命体征指标和睡眠质量。     

急诊外科中静脉快速滴注高渗盐液对脑外伤并休克患者预后的影响

目的 探讨急诊外科中静脉快速滴注高渗盐液对脑外伤并休克患者预后的影响。方法 选取2020年10月至2023年10月我院急诊外科收治的84例脑外伤并休克患者为研究对象,以随机数字表法将其分为观察组（n=42,静脉快速滴注高渗盐液）和对照组（n=42,甘露醇+碳酸氢钠注射液）。比较两组的生命体征、格拉斯哥昏迷评分（GCS）、美国国立卫生研究院卒中量表（NIHSS）、简易智力状态检查量表（MMSE）评分及临床疗效。结果 治疗30 min后、治疗2 h后,观察组的呼吸频率、心率（HR）、尿量优于对照组（P<0.05）。治疗1周后,观察组的GCS、MMSE评分高于对照组,NIHSS评分低于对照组（P<0.05）。观察组的治疗总有效率高于对照组（P<0.05）。结论 静脉快速滴注高渗盐液能有效促进脑外伤并休克患者的生命体征改善和神经功能恢复。     

高渗盐液用于失血性休克复苏的研究进展

失血性休克的液体治疗一直是临床急救医学所关注的问题。失血性休克是多种创伤急症的共同表现,其病理生理特点是血容量急剧减少,导致有效循环血容量不足,心脏排血量减少,组织灌流量不足,引起细胞缺氧。自1980年Velasco等首次报道用7．5％NaCl成功地治疗严重失血性休克的动物实验后,国内外有关高渗盐液（hypertonic saline or hypertonic saline solutions,HS）治疗休克的研究不断深入。现就高渗盐液用于失血性休克复苏的研究进展简要综述如下。     

高渗盐复合液治疗急性颅内高压伴失血性休克患者的临床观察北大核心CSCD

目的通过观察高渗盐复合液（HSH）对重型颅脑外伤颅内高压并失血性休克患者的平均动脉压（MAP）、中心静脉压（CVP）和颅内压（ICP）的变化,以及随访6个月预后GOS评分的变化,探讨HSH治疗重型颅脑外伤颅内高压并休克患者的临床疗效。方法①选择在上海市静安区闸北中心医院ICU及脑外科住院治疗的创伤重型颅脑损伤并失血性休克患者60例,病情评估昏迷程度按GCS评分,休克严重程度按休克指数（SI）评分;随机（随机数字法）分为高渗盐复合液组（HSH组）30例,甘露醇组（MT组）30例。②观察两组患者给药后30min、60min、120min的MAP、CVP和ICP的变化,并随访6个月观察患者的预后。结果①两组患者的年龄、性别、GCS评分、SI评分及其他合并用药等方面差异均无统计学意义（P〉0．05）,有可比性。②复苏后两组患者MAP及CVP均升高,但HSH组30min内即见效[MAP（63．1±8．8）mmHg椰．（51．0±9．3）mmHg]（P〈0．05）;同时ICP降低10％以上[ICP（27．3±5．9）mmHg傩．（32．8±4．1）mmHg]（P〈0．05）,而MT组较迟出现血流动力学改善;120min时HSH组升高MAP和降低ICP的作用仍较MT组显著[MAP〈65．9±13．2）mmHg摊．（60．4±7．2）mmHg]（P〈0．01）;[ICP（22．2±4．7）mmHg1）8．（28．1±6．1）mmHg]（P〈0．01）。③随访6个月,HSH组恢复良好率优于MT组,恢复不良率低于MT组。④两组均未发生药物不良反应。结论对于急性颅内高压伴失血性休克的患者,高渗盐复合液能更快更有效地纠正休克和降低颅内压,改善患者的长期预后。     

ICU治疗重度颅脑损伤患者的临床效果

目的分析ICU治疗方法应用于重度颅脑损伤患者的临床治疗效果。方法选取2012年3月至2013年8月济源市人民医院收治的重度颅脑损伤患者60例,随机分为两组,每组30例。对照组采取常规方法治疗,观察组采取ICU治疗,比较两组的临床治疗效果。结果经过治疗后,两组患者的临床症状均有所改善,对照组临床总有效率为66.67%(20/30),观察组为93.33%(28/30),观察组显著高于对照组,差异有统计学意义(χ2=0.010,P0.05),对照组并发症发生率为10%,观察组3.3%,两组比较差异未见统计学意义(χ2=0.301,P0.05)。结论 ICU治疗用于重度颅脑损伤患者的治疗中能有效缓解患者的症状,提高患者的治愈率,从而改善患者的生活质量,效果显著,值得临床上广泛的推广与应用。     

高渗液复苏休克的评价

高渗晶体液用于临床已有多年历史。本世纪20年代有人用高渗NaCl治疗闭塞性血栓性动脉炎时,就发现它的增大脉搏波幅的短暂作用。1946年Danowski等用高渗NaCl复苏休克,循环迅速恢复正常。此后陆续有人报道用高渗晶体液治疗低血容量休克,不仅能使失血动物的血压回升,耐受低容量的时间延长,组织损害减轻,而且远较等渗NaCl的死亡率低。高渗液复苏休克的问题,近年来重新引起了人们的关注,继续进行探讨。本文综述有关资料,以供临床使用参考。 低血容量休克对高渗晶体液的效应 低血容量动物输注小量高渗液后,血液动力学的各项监测指标均明显改善。可见每搏血量及心输     

高渗高张液治疗失血性休克临床观察

近年来随着工农业生产的发展和交通事故的增多，创伤、失血性休克随之增多，而迅速有效地恢复和维持血容量是创伤、失血性休克急救复苏的关键之一。我科自2003以来在临床上应用高张高渗液治疗失血性休克52例，效果满意，现报告如下：     

高渗盐水治疗重型颅脑创伤合并休克的疗效研究

目的探讨高渗盐水对重型颅脑创伤合并休克患者的治疗疗效。方法回顾性分析88例严重颅脑创伤合并休克患者的病例资料,根据治疗方案分为两组:A组38例,采用7.5%高渗盐水治疗;B组50例,采用20%甘露醇治疗,监测两组入院后用药4h内各患者颅内压(ICP)、平均动脉压(MAP)、脑灌注压(CPP)和血钠浓度等的变化及评估患者远期的转归。结果 A组和B组比较,用药即时、0.5h、1h时ICP差异均无统计学意义(t分别=-1.92、1.32、0.28,P均>0.05),但A组用药2h和4h时ICP明显低于B组,差异均有统计学意义(t分别=-5.79、-9.32,P均<0.05),且A组患者CPP明显高于B组,差异均有统计学意义(t分别=8.08、7.60,P均<0.05)。两组用药2h内的血钠浓度差异均无统计学意义(t分别=0.86、0.50、0.43、1.83、1.20,P均>0.05)。在远期转归上,两组在6h内死亡率、28d存活率、院内感染率及需处理的高钠血症发生率上差异均无统计学意义(χ2分别=0.54、1.09、0.02、0.12,P均>0.05)。结论重型颅脑创伤合并休克患者早期应用7.5%高渗盐水,不仅能够安全有效地降低ICP,还能够提高患者CPP,有利于休克病人的复苏。     

Administering hypertonic saline to patients with severe traumatic brain injury.

Hypertonic saline (HTS) is an osmotic agent that can help patients in the acute phase of severe traumatic brain injury. HTS extracts fluid from swollen cerebral tissue to both control intracranial pressure and diminish the deleterious effects of secondary brain injury. Neuroscience nurses in intensive care and acute care units, who may administer HTS as resuscitation fluid, continuous infusion, or bolus dose, need to be familiar with physiologic actions, potential side effects, and appropriate HTS administration techniques. Neuroscience nurses collaborate with other members of the interdisciplinary team to ensure that HTS is administered safely.     

高渗盐水复苏对急性脑损伤伴失血性休克患者颅内压脑氧代谢的影响

目的　研究高渗盐水 (HTS)复苏对急性脑损伤伴失血性休克患者颅内压、脑氧代谢的影响。方法　 4 6例急性脑损伤伴失血性休克患者随机分为 3组 :HTS治疗组、甘露醇 (MT)治疗组和平衡液对照组。在平衡液复苏基础上 ,分别在 15min内快速静脉输入 7 5 %HTS 4mL/kg和 2 0 %MT 0 5g/kg。于治疗后 15、30、6 0、12 0min通过侧脑室置管监测颅内压 (ICP) ,计算脑灌注压 (CPP) ;同时分别抽取动脉、颈内静脉球部血行血气分析 ,监测颈静脉血氧饱和度 (SjvO2 )及脑动静脉氧含量差 (Da -jvO2 )。结果　与对照组比较 ,HTS能明显降低ICP ,增加CPP ,改善脑氧供需平衡 (P <0 0 1) ;与MT组比较 ,HTS组降低ICP幅度与其相似(P >0 0 5 ) ,而降ICP作用维持时间较长 ,于治疗后 12 0minICP、CPP值与MT组比较差异有显著意义 (P <0 0 1)。结论　HTS降低ICP效果确切 ,且维持时间较长 ,同时可改善脑氧代谢 ,适于急性脑损伤伴失血性休克患者的急救治疗     

Opposed effects of hypertonic saline on contusions and noncontused brain tissue in patients with severe traumatic brain injury

OBJECTIVE: The aim of this study was to quantify the effect of hypertonic saline solution on contused and noncontused brain tissue in patients with traumatic brain injury. We hypothesize that hypertonic saline would increase the volume of brain contusion while decreasing the volume of noncontused hemispheric areas. DESIGN: Prospective observational study. SETTING: Neurosciences critical care unit of a university hospital. PATIENTS: Fourteen traumatic brain injury patients with increased intracranial pressure. INTERVENTIONS: A computed tomography scan was performed before and after a 20-min infusion of 40 mL of 20% saline. MEASUREMENTS AND MAIN RESULTS: The volume, weight, and specific gravity of contused and noncontused hemispheric areas were assessed from computed tomography DICOM images by using a custom-designed software (BrainView). Physiologic variables and natremia were measured before and after infusion. Hypertonic saline significantly increased natremia from 143 +/- 5 to 146 +/- 5 mmol/L and decreased intracranial pressure from 23 +/- 3 to 17 +/- 5 mm Hg. The volume of the noncontused hemispheric areas decreased by 13 +/- 8 mL whereas the specific gravity increased by 0.029 +/- 0.027%. The volume of contused hemispheric tissue increased by 5 +/- 5 mL without any con-comitant change in density. There was a wide interindividual variability in the response of the noncontused hemispheric tissue with changes in specific gravity varying between -0.0124% and 0.0998%. CONCLUSIONS: Three days after traumatic brain injury, the blood- brain barrier remains semipermeable in noncontused areas but not in contusions. Further studies are needed to tailor the use of hypertonic saline in patients with traumatic brain injury according to the volume of contusions assessed on computed tomography.     

ICU重度颅脑损伤患者肺部感染临床特征分析

[目的]探讨ICU重度颅脑损伤患者并发肺部感染的危险因素.[方法]对53例重度颅脑损伤并发肺部感染患者的临床资料进行回顾性分析.[结果]同期共收治165例重度颅脑损伤患者,其中53例合并肺部感染,感染率为32.1%.经单因素分析发现,气管切开史、住院天数≥20 d、基础疾病史、休克史和呼吸机应用史是ICU重度颅脑损伤并发肺部感染的危险因素.主要致病菌以革兰阴性杆菌为主,占72.7%,其次是革兰阳性球菌,占22.7%,真菌占4.6%.[结论]ICU重度颅脑损伤并发肺部感染与多种临床因素密切相关,其预后差,病死率高.     

The effect of hypertonic saline and mannitol on coagulation in moderate traumatic brain injury patients

Background

Hyperosmolar therapy, using either hypertonic saline (HTS) or mannitol (MT), is considered the treatment of choice for intracranial hypertension, a disorder characterized by high intracranial pressure (ICP). However, hyperosmolar agents have been postulated to impair coagulation and platelet function. The aim of this study was to identify whether HTS and MT could affect coagulation in moderate traumatic brain injury (TBI) patients.

Use of hypertonic saline in the treatment of severe refractory posttraumatic intracranial hypertension in pediatric traumatic brain injury

OBJECTIVES: To evaluate the effect of prolonged infusion of 3% hypertonic saline (514 mEq/L) and sustained hypernatremia on refractory intracranial hypertension in pediatric traumatic brain injury patients. DESIGN: A prospective study. SETTING: A 24-bed Pediatric Intensive Care Unit (Level III) at Children's Hospital. PATIENTS: We present ten children with increased intracranial pressure (ICP) resistant to conventional therapy (head elevation at 30 degrees, normothermia, sedation, paralysis and analgesia, osmolar therapy with mannitol, loop diuretic, external ventricular drainage in five patients), controlled hyperventilation (Pco2, 28-35 mm Hg), and barbiturate coma. We continuously monitored ICP, cerebral perfusion pressure (CPP), mean arterial pressure, central venous pressure, serum sodium concentrations, serum osmolarity, and serum creatinine. INTERVENTIONS: A continuous infusion of 3% saline on a sliding scale was used to achieve a target serum sodium level that would maintain ICP <20 mm Hg once the conventional therapy and barbiturate coma as outlined above failed to control intracranial hypertension. MEASUREMENTS AND MAIN RESULTS: The mean duration of treatment with 3% saline was 7.6 days (range, 4-18 days). The mean highest serum sodium was 170.7 mEq/L (range, 157-187 mEq/L). The mean highest serum osmolarity was 364.8 mosm/L (range, 330-431 mosm/L). The mean highest serum creatinine was 1.31 mg/dL (range, 0.4-5.0 mg/dL). There was a steady increase in serum sodium versus time zero that reached statistical significance at 24, 48, and 72 hrs (p < .01). There was a statistically significant decrease in ICP spike frequency at 6, 12, 24, 48, and 72 hrs (p < .01). There was a statistically significant increase in CPP versus time zero at 6, 12, 24, 48, and 72 hrs (p < .01). There was a statistically significant increase in serum osmolarity versus time zero at 12 hrs (p < .05) and at 24, 48, and 72 hrs (p < .01). Two patients developed acute renal failure and required continuous veno-venous hemodialysis; these were concurrent with an episode of sepsis and multisystem organ dysfunction. Both recovered full renal function with no electrolyte abnormalities at the time of discharge. CONCLUSION: An increase in serum sodium concentration significantly decreases ICP and increases CPP. Hypertonic saline is an effective agent to increase serum sodium concentrations. Sustained hypernatremia and hyperosmolarity are safely tolerated in pediatric patients with traumatic brain injury. Controlled trials are needed before recommendation of widespread use.     

Hyperosmolar therapy in the treatment of severe head injury in children: mannitol and hypertonic saline

Traumatic brain injury is the result of a primary, acute injury and is complicated by the development of secondary injury due to hypotension and hypoxia. Cerebral edema due to brain injury compromises the delivery of essential nutrients and alters normal intracranial pressure. The Monroe-Kellie Doctrine defines the principles of intracranial pressure homeostasis. Treatment for intracranial hypertension is aimed at reducing the volume of 1 of the 3 intracranial compartments, brain tissue, blood, and cerebrospinal fluid. Hyperosmolar therapy is one treatment intervention in the care of patients with severe head injury resulting in cerebral edema and intracranial hypertension. The effect of hyperosmolar solutions on brain tissue was first studied nearly 90 years ago. Since that time, mannitol has become the most widely used hyperosmolar solution to treat elevated intracranial pressure. Increasingly, hypertonic saline solutions are being used as an adjunct to mannitol in basic science research and clinical studies. Hyperosmolar solutions are effective in reducing elevated intracranial pressure through 2 distinct mechanisms: plasma expansion with a resultant decrease in blood hematocrit, reduced blood viscosity, and decreased cerebral blood volume; and the creation of an osmotic gradient that draws cerebral edema fluid from brain tissue into the circulation. The pediatric section of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies adapted previously published guidelines for the treatment of adult brain injury into guidelines for the treatment of children with traumatic brain injury. These guidelines offer recommendations for the management of children with severe head injury, including the use of mannitol and hypertonic saline to treat intracranial hypertension. Acute and critical care pediatric advanced practice nurses caring for children with severe head injury should be familiar with management guidelines and the use of hyperosmolar solutions. The purpose of this article is to assist the advanced practice nurse in understanding the role of hyperosmolar therapy in the treatment of pediatric traumatic brain injury and review current guidelines for the use of mannitol and hypertonic saline.     

小剂量高渗液在烧伤休克复苏中的临床观察

目的探讨小剂量高渗液在烧伤休克患者复苏中的临床效果和安全性。方法60例烧伤患者随机分为观察组和对照组,各30例,观察组给予高渗盐溶液,对照组给予平衡盐溶液,其余复苏方式相同;复苏总量采用复苏补液公式计算,根据尿量调整液体总量;比较两组患者的临床治疗效果。结果经过治疗后,观察组患者的血压、尿量、乳酸值和红细胞渗透脆性等方面与对照组差异有统计学意义（P〈0．05）。结论小剂量高渗液具有明显的抗休克和稳定红细胞膜作用,有一定的临床应用价值。     

62例重型颅脑外伤伴休克的救治

目的探讨重型颅脑外伤伴休克的救治方案。方法回顾2002-01～2006-12间收治的62例重型颅脑伤伴休克病例。全部患者入院时均有不同程度休克表现。GCS≤8分,ISS评分平均32.6分。抢救按照损伤控制外科的原则而进行,以抢救生命为主,抓好呼吸、循环及脑受压三个重要环节,颅内血肿、脑疝伴其他部位损伤并休克者两个部位同时手术。全部病例均收住EICU,重点进行生命体征监护,各个脏器功能保护,控制感染,注重早期肠道营养,防治MODS出现。结果治愈22例(35.5%),轻残6例(9.7%),重残15例(24.2%),植物生存5例(8.1%),死亡14例(22.6%)。死亡原因:脑疝晚期中枢神经功能衰竭2例,不伴脑疝的严重创伤性休克5例,术后患者因多器官功能衰竭7例。结论重型颅脑伤并休克救治重点是颅内血肿、脑疝、休克和呼吸功能障碍,治疗中统筹兼顾,遵循损伤控制外科的原则,必要时两个部位同时手术以挽救患者的生命。强调了新急诊模式及EICU在抢救中的重要地位。