高渗盐水用于重度颅脑损伤伴失血性休克患者的急诊救治

目的：评价高渗盐水（HTS）在重度颅脑损伤伴失血性休克的急诊应用价值。方法：将28例重度颅脑损伤伴失血性休克患者随机分高渗盐水组（HTS）和甘露醇组（MT）,分别给予7.5%高渗盐水（4ml/kg）及20%甘露醇250ml。监测颅内压（ICP）、平均动脉压（MAP）、脑灌注压（CCP）、电解质及尿量。结果：HTS组在用药30min后ICP下降,而MT组在45min后下降,HTS组维持时间长达120min。而两组用药后MAP、CPP及生化均保持稳定。结论：与MT组比较,7.5%高渗盐水在降颅内压同时抗休克,且表现更快、更持久,适用于现场抢救及急诊室初步处理。

The resuscitation of patients with severe head injury and hemorrhagic shock by hypertonic saline in emergency

Objective: To estimate the value of hypertonic saline for the patients with severe head injury and hemorrhagic shock in emergency.Methods: 28 patients with severe head injury and hemorrhagic shock were randomly divided into hypertonic saline group(HTS) and mannitol group(MT),then respectively infused 7.5% hypertonic saline(4ml/kg) and 20% mannitol 250ml.Intracranial pressure(ICP),mean arterial pressure(MAP),cerebral perfusion pressure(CPP),blood electrolyte and urinary output(UOP) were all monitored.Results: ICP were reduced after 30 minuts of infusion in HTS group,45 minuts in MT group.The maintenance time was longer in HTS group,especially within 120 minuts.MAP,CPP and blood electrolyte were steady after infusion.Conclusion: To reduce the CPP and countershock at the same time,the effects are faster and more lasting in HTS group than in MT group.7.5% hypertonic saline is suitable for salvage at scene and initial treatment in emergency ward.