复方甘油治疗脑水肿降低颅内压的疗效观察

通过３２例高颅压患者甘油和甘露醇交替给药的疗效比较，结果显示两药的总有效率及降ＩＣＰ作用类似；但两药物ＩＣＰ的显效时间，持续时间不同，尿量及尿比重也显著差异，所以甘露醇适于急性颅压增高患者的急救，而甘油适于需长期脱水治疗的患者。     

重型颅脑损伤患者甘露醇、速尿和白蛋白降颅压作用的临床观察

目的观察甘露醇、速尿和白蛋白在不同使用方法和剂量上的降颅压效果,探讨临床合理的药物降颅压方法。方法124例重型颅脑损伤患者随机分为5组,全部进行持续颅内压(ICP)监测,连续观察静脉使用甘露醇、速尿和白蛋白后的ICP、血钾、血钠和血尿素氮(BUN)的变化。结果甘露醇和速尿降ICP作用明显(P<0.05);半量甘露醇加速尿或白蛋白降ICP作用显著(P<0.05)且持续时间长(P<0.05);降ICP的过程中可能出现电解质、肾功能的异常和ICP的反跳现象。结论半量甘露醇+速尿降ICP的方法值得临床提倡;半量甘露醇联合使用中、大剂量白蛋白在有条件的情况下也是适宜的降ICP方法。     

持续颅内压监测指导重型颅脑损伤开颅术后甘露醇的应用

目的探讨持续动态颅内压(ICP)监测指导重型颅脑损伤(sTBI)患者行开颅脑血肿清除术和(或)去骨瓣减压术后甘露醇使用的临床价值。方法对20例sTBI开颅术后患者行持续ICP监测,根据ICP数值作个体化甘露醇脱水降颅压,并与同期未行ICP监测的21例开颅术后患者的甘露醇应用时间和计量、术后并发症、预后进行比较。结果监测组甘露醇使用时间及计量较对照组低,监测组术后总并发症(迟发性脑血肿、大面积脑梗塞、弥漫性脑肿胀、电解质紊乱、急性肾功能损害)发生率较对照组低;监测组GOS预后评分优于对照组。结论持续动态ICP监测能及时反应sTBI开颅术后ICP的变化,通过个体化精准降颅压治疗有效控制ICP,维持脑灌注压,减少甘露醇的使用,减少术后并发症的发生,改善sTBI患者预后和生存率。     

甘油果糖注射液降低颅内压的临床观察

对４６例颅内压增高患者用甘油果糖静脉注射液５００ｍｌ降低颅内压并与２８例用甘露醇降颅压者进行对比，注射甘油果糖后０．５９±０．３９小时颅压开始下降，２．２３±０．４６小时作用达高峰，持续６．０３±１．５２小时，降颅压幅度为１．３３±０．６７ｋＰａ（１０．３６±５．３５ｍｍＨｇ），无反跳现象，对肾影响小；而注射２０％甘露醇２５０ｍｌ后０．４０±０．１７小时颅压开始下降，０．９７±０．２９小时作用达高峰，作用持续４．７３±１．４６小时，５０％病例出现反跳现象。认为甘油果糖注射液适用于需较长期降颅压及肾功能有损害者。     

闪光视觉诱发电位监测甘露醇降颅压效果的临床研究

目的利用闪光视觉诱发电位监测颅内高压患者颅压水平,研究降颅压效果与甘露醇用量以及其他影响因素的关系。方法选择60例颅内高压患者,应用NIP-200型无创颅内压监测仪监测患者每日颅压,计算最高颅压与最低颅压间的差值(降颅压效果),采用多元逐步回归方法分析降颅压效果与性别,年龄,最高颅压时的心率、血压以及降至最低颅压时甘露醇总用量的关系。结果60例患者最低颅压平均值为(213·4±66·8)mmH2O(83·5~364·5mmH2O),患者的颅压水平从入院至最低值时甘露醇总用量的平均值为(1870·8±861·9)ml(375~4000ml)。降颅压效果与最高颅压时的血压(舒张压和收缩压)和心率无相关性(P>0·05),与性别、年龄显著相关(P<0·05),与甘露醇用量显著相关(P<0·01)。结论甘露醇有明显的降颅压作用,但是用到一定的剂量后,便不再有降颅压作用。女性患者比男性患者降颅压的效果好。患者年龄越小,降颅压效果越好。     

高渗盐水治疗脑损伤性颅高压有效性与安全性的Meta分析

目的 运用Meta分析评价高渗盐水对比甘露醇治疗脑损伤性颅高压的有效性与安全性。方法 系统检索知网、万方、生物医学、维普筛选高渗盐水比对甘露醇治疗脑损伤性颅高压的随机对照实验(RCTs)并提取相关数据。采用Rev Man 5.3软件对相关数据进行合并分析。结果 共纳入26篇符合纳入标准的RCTs文献,共1 903例患者。Meta分析结果显示,高渗盐水降颅压方案组在给药后多数结局终点的颅内压、药效时长、脑灌注压、不良事件领域与甘露醇组的差异均有统计学意义。亚组分析显示,3%的高渗盐水降颅压效力略低于20%甘露醇; 7.5%、10%、23.4%高渗盐水降颅压效力与20%甘露醇相当。针对7.5%高渗盐水不同给药剂量的亚组分析提示,4 m L/kg剂量是降颅压的较优剂量。结论 基于中国人群RCTs的合并结果,4 m L/kg剂量的7.5%的高渗盐水可能是较优的降颅压方案,本结论仍需高质量RCTs进一步验证,此外针对不同人群和种族的最佳治疗方案仍需进一步研究。     

甘油果糖并用甘露醇治疗急性脑血管病70例疗效观察

我科在2004--06～2005～06对急性脑血管病病人采用甘油果糖并用甘露醇的方法。进行降颅压治疗．取得了良好疗效，现报告如下。     

甘露醇引起静脉损伤的预防和护理

甘露醇在临床应用相当广泛，用于降颅压减轻脑水肿。但此药对局部静脉损伤严重，重则引起无菌性炎症，甚至不可逆性损伤。     

甘油果糖注射液治疗颅内高压症的临床分析

目的探讨甘油果糖对颅内高压的临床疗效。方法将66例颅内高压组病人随机分为2组,研究组34例应用甘油果糖(250m1,ivgtt q8h),对照组32例应用甘露醇(250mL,ivgtt q8h);根据脑卒中患者神经功能缺损评分标准评判治疗效果。结果甘油果糖可明显缓解颅内高压引起的临床症状同时降低脑脊液压力且不良反应少。结论甘油果糖降颅压作用可靠且安全性高。     

甘油、甘露醇和Lasix在脑卒中急性期的脱水作用

直肠导入脱水剂是一个简单而有效的方法,作者介绍应用40—45％甘油、40—45％甘露醇、10—15％Lasix经直肠点滴导入、观察167例脑卒中(包括出血性卒中及缺血性卒中、女性及男性)急性期的降颅压效果;甘油和甘露醇按每公斤体重0.5克给予,速度每分钟120—130滴,研究项目包括脑电阻图、脑电图、心电图、脑脊液压力、动脉压及脉搏     

Mathematical model of brain edema and optimal control of intracranial pressure

It is necessary to analyse various parameters responding to hypertonic solutions such as mannitol or glycerol, in order to achieve the best therapeutic results for patients having increased intracranial pressure (ICP). The responding model system for the ICP composing of multi-compartments of blood and brain tissue was mathematically introduced. By analysing the changes of the ICP under administration of glycerol using this system, the mathematical model for brain edema was developed. The cause of water transfer in this model system was indicated as the difference of the osmotic pressure and determined as ICP increasing factor, V. It was demonstrated that this theoretical model responded quite similarly to human ICP monitored by sumulating this system for clinical cases. The ICP controller was further developed. The automatic control of ICP was clinically achieved by using this controller. The minimal effective dose of glycerol can be automatically administered by presetting a desirable ICP for each patient.     

Rebound phenomenon of mannitol and glycerol: clinical studies

A rebound phenomenon after infusion of hypertonic solution of mannitol and glycerol on raised intracranial pressure was studied by epidural pressure recordings for 65 patients. The mean age of the patients was 50 years with a range of 29 to 73 years. The diagnoses of above patients were as follows; 29 were cerebral aneurysms, 19 were brain tumors, 10 were hypertensive intracerebral hemorrhages, 4 were cerebral contusions, 2 were arteriovenous malformations, and one was cerebral abscess. Four methods of infusion were performed. In group A, 0.5 g/kg of mannitol was infused within 15, 30 or 60 minutes. In group B, 1.0 g/kg of mannitol was infused within 30, 60 or 90 minutes. In group C, 0.5 g/kg of glycerol in 5% fructose was infused within 30, 60 or 90 minutes. In group D, 1.0 g/kg of glycerol in 5% fructose was infused within 60, 120 or 180 minutes. The following observations were examined in all patients. (1) The occurrence of the rebound phenomenon. (2) The rate of the raised intracranial pressure (ICP) compared to the ICP before infusion of these hypertonic solutions. (3) The duration of the rebound phenomenon. Results: A rebound phenomenon was found 23% in all patients, and 12% in the mannitol groups and 34% in the glycerol groups. The dose and the rate of mannitol infusion did not influence the occurrence of the rebound phenomenon. In contrast, in the glycerol groups, the infusion method did influence the occurrence of the rebound phenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of NIK-242 inj. (20% erythritol) on intracranial pressure in dogs with acute obstructive hydrocephalus

The effects of NIK-242 inj. (20% erythritol) on intracranial pressure (ICP) and serum osmotic pressure (Osm. P) were investigated in dogs with acute obstructive hydrocephalus, and they were compared with those of 20% mannitol or 10% glycerol in 5% fructose and 0.9% saline. Animals were divided into 5 groups (n = 6 in each group) and treated with either NIK-242 inj. (0.5 g/kg, 1.0 g/kg, 2.0 g/kg), mannitol (1.0 g/kg) or glycerol (0.5 g/kg). These drugs were administrated intravenously for 10 min. NIK-242 inj. rapidly reduced ICP and increased Osm. P. There was correlation between changes of ICP and Osm. P. The regression equation was Y = -6.489 X + 726.206 (n = 104, p less than 0.00001, R = -0.655). The effects were dose-dependent, but there were no significant differences between the effects of NIK-242 inj. 1.0 g/kg infusion and 2.0 g/kg infusion. The most appropriate dose of NIK-242 inj. was 1.0 g/kg, in which group ICP was significantly lower than the initial pressure until 120 minutes after administration (p less than 0.05). The maximum reduction rate of ICP [(initial ICP-minimum ICP)/initial ICP X 100] was 83.6 +/- 10.6% at 22.7 +/- 3.0 min. after administration. It was 61.6 +/- 6.9% at 19.3 +/- 1.6 min. in mannitol group and 77.1 +/- 7.4% at 15.0 +/- 0.8 min. in glycerol group. There was no rebound phenomenon on ICP during 150 min., but there was one in mannitol group and five in glycerol group. NIK-242 inj.(ABSTRACT TRUNCATED AT 250 WORDS)     

高渗盐液与甘露醇对颅内压增高治疗效果的系统评价

目的系统评价高渗盐液对颅内压增高的治疗效果。方法计算机检索Medline、中国知网、维普数据库和万方数据库中关于高渗盐液与甘露醇降低颅内压增高的随机对照试验（RCT）,同时追索纳入文献的参考文献,对符合质量标准的RCT进行Meta分析。结果共纳入11项RCT共275例患者。Meta分析表明：高渗盐液对颅内压增高的成功控制率（92_31％）较甘露醇（74．44％）明显增高（P〈0．01）;高渗盐液对颅内压降低程度较甘露醇更大（P〈O．01）;高渗盐液较甘露醇作用持续时间更长（P〈0．01）。但是两组患者生存率没有统计学差异（P〉0．05）。结论高渗盐液较甘露醇更能有效地降低颅内压增高且持续时间更长,在临床上可推荐使用。     

Long-time microdialysis in a patient with meningoencephalitis

As part of invasive neuromonitoring, long-time microdialysis was performed in a 32-year-old patient suffering from meningoencephalitis. Cerebral magnetic resonance imaging (MRI) revealed marked global brain oedema. An intracranial pressure (ICP) probe, brain tissue oxygen pressure measurement (pTiO(2)), and intraparenchymal microdialysis were used for intensive neuromonitoring. Despite high ICP, only intensive care therapy was applied for 16 days using deep propofol sedation, hyperventilation, and intermittent mannitol therapy. One year later, the condition of the patient was excellent. Intracerebral microdialysis with bedside measuring of lactate, pyruvate, glycerol, glucose, and glutamate is a useful additional tool for the monitoring of ICP management.     

康容注射液有效降低颅内压作用的临床研究

目的探讨康容注射液降低颅内压的效果。方法由于颅脑损伤、颅内肿瘤、脑血管病等原因所致的急性颅内压升高的患者120例,随机平均分为研究组和对照组。研究组静脉快速输注20%康容注射液,对照组静脉快速输注20%甘露醇。所有患者均采用持续的颅内压监护或者定时的腰椎穿刺测定颅内压力,并同时观测药物的安全性、有效性以及可能出现的各种副作用。结果研究组中显效6例,有效18例,进步33例,无效3例;对照组中显效9例,有效15例,进步33例,无效3例。两组的总有效率均为95%(57/60),无明显差别。在用药期间和用药后研究组未发现任何与所用药品有关的局部及全身不良反应,对血象和肝肾功能无不良影响。对照组中1例患者出现急性肾功能损害。结论康容注射液具有较强的降低颅内压作用,对肝肾功能无损害,比甘露醇更适合老年或有肝肾功能损害的急性颅内压增高的病人。     

康容注射注液降低颅内压作用的临床研究

目的探讨康容注射液降低颅内压的效果。方法颅脑损伤引起的颅内压增高病人62例,随机平均分为实验组和对照组。实验组静脉快速输注20％康容注射液,对照组静脉快速输注20％甘露醇。所有病人均进行连续的颅内压监护,并同时观察其可能出现各种副作用。结果实验组显效4例,有效12例,进步13例,无效2例;对照组显效2例,有效13例,进步13例,无效3例。两组的总有效率分别为93.5％(29/31)和90.3％(28/31),相差无显著性(P>0.05)。在用药期间和用药后两组均没有观察到与所用药品有关的副作用。结论康容注射液具有与甘露醇相同的降颅内压效果,且无明显副作用,在临床上可用于降低各种原因引起的颅内压升高。     

颅内压增高及甘露醇治疗患者的脑血流动力学变化

目的　研究颅内压增高患者的脑血流动力学变化特征 ,并探讨TCD和甘露醇对患者的诊断治疗作用。方法　对 4 0例颅内压增高患者进行TCD检测 ,其中 15例行甘露醇治疗前后动态观察。结果　颅内压增高患者脑血流速度 (Vd ,Vs)减慢 ,血管阻力参数值 (PI ,RI)增大 ,甘露醇治疗后各检测参数明显改善 ,并以舒张期流速及脉动指数为著。结论　根据脑血流动力学的特征性改变 ,结合试验性甘露醇治疗 ,TCD为无创性诊断和动态观察颅内压增高提供了依据     

动态颅内压监测对重型颅脑损伤标准大骨瓣减压术后治疗的意义

目的探讨动态颅内压(ICP)监测对重型颅脑损伤(sTBI)标准大骨瓣减压术治疗的指导意义。方法对62例(监测组)sTBI标准大骨瓣减压患者术后行ICP监测,根据ICP值调整治疗方案,并与同期未行ICP监测的46例(常规组)sTBI标准大骨瓣减压患者的疗效、并发症及甘露醇应用的时间和计量作比较。结果监测组脱水剂应用时间及剂量较未监测组低,监测组急性肾功能损伤和电解质紊乱发生率较未监测组低,而肺部感染、尿路感染和上消化道出血等三种并发症方面差异无统计学意义;监测组预后优于常规组。结论动态ICP监测能较好地反应sTBI标准大骨瓣减压术后ICP的变化,通过个体化治疗能有效控制ICP,维持脑灌注压,减少并发症,降低sTBI的致残率和病死率。     

Usefulness of intracranial pressure monitoring and EEG analysis in a child with acute encephalitis

The usefulness of continuous intracranial pressure (ICP) monitoring and the correlation between ICP and electroencephalographic findings were investigated in a 6-year-old boy with acute encephalitis. On admission he was comatose in a decerebrate posture. ICP was continuously monitored by the epidural transducer and controlled with hyperventilation, fluid restriction and administration of mannitol, glycerol and pentobarbital to keep below 20 mm Hg. The inotropic agents such as dopamine and dobutamine were also given to maintain the cerebral perfusion pressure (CPP) at 50 mm Hg or greater. At the same time with ICP monitoring, EEG records were obtained with scalp electrodes at monopolar T3-A1 and T4-A2 regions according to the 10-20 international system on an analog tape simultaneously with a data recorder. The records were digitized at 50 samples/sec, and the high-order auto-regressive (AR) power spectrum was calculated with a minicomputer PFU-1200 (Fujitsu Co Ltd.). At pressures greater than 25 mm Hg in ICP, the total power of the high-order AR activity of EEG was apparently decreased. The results indicated that the AR power spectral analysis of EEG is sensitive method for obtaining valuable information regarding the electrical brain activity and intracranial pressure.