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。

Effects of mannitol, furosemide and albumin on reducing the intracranial pressure in patients with severe brain injury

Objective To investigate the effect of reducing intracranial pressure with mannitol, furosemide and albumin. Methods 124 patients were randomly divided into 5 groups: Group A, 20% mannitol 250 mL each time as control; Group B, 20% mannitol 125 mL each time; Group C, shift with 20% mannitol 250 mL each time or 40 mg furosemide; Group D, shift with 20% mannitol 125 mL each time or 25 mg furosemide; Group E, shift with 20% mannitol 250 mL + albumin at middle or large dose. They were monitored in intracranial pressure, and observed in the changes of intracranial pressure, blood potassium, blood natrium and blood urea nitrogen after the use of mannitol, furosemide and albumin. Results All the drugs reduced the patients' intracranial pressure (P<0.05), but mannitol was more significant (P<0.05) and the combination of mannitol and furosemide was the most significant (P<0.001) and even lasted longer (P<0.01). Conclusion Mannitol at half dosage is most effective in reducing intracranial pressure but interval between two administrations is suggested to be within 4 h. Combined use of mannitol and furosemide to reduce intracranial pressure is worth advocating, but it is very important to keep balance of water and electrolures.