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

Effects of hypertonic saline on intracranial pressure and cerebral oxygen metabolism in patients with severe traumatic brain injury and hemorrhagic shock

Objective To explore the effects of hypertonic saline on intracranial pressure (ICP) and the balance of cerebral oxygen supply and consumption in patients with severe traumatic brain injury and hemorrhagic shock. Methods Forty-six patients with brain injury and hemorrhagic shock were divided into three groups: hypertonic saline (HTS), mannitol (MT) and equilibrium liquid control group. The treated group were given rapidly an intravenous infusion of 4 mL/kg of 7% saline solution or 0.5 g/kg of 20% mannitol in 15 minutes besides equilibrium liquid therapy. The changes of indexes were examined at 15, 30, 60 and 120 min after liquid therapy. ICP were monitored through intracerebroventricular catheters. Internal jugular vein was retrogradely cannulated and radial artery was cannulated for blood sample and blood gas analysis. ICP, CPP, jugular venous oxygen saturation (SjvO 2), arteriovenous difference of oxygen content (C(a-jv)O 2) were measured and calculated. Results Compared with control group, ICP decreased and CPP, SjvO 2 increased significantly by HTS and MT ( P <0 01). There were no significant differences in ICP, CPP, SjvO 2 and C(a-jv)O 2 between HTS and MT at 15, 30, 60 min, but the effects of HTS on ICP was longer than MT. At 120 min there were significant difference in ICP, CPP between HTS and MT. Conclusion HTS is comfortable for emergency treatment of patients with brain injury and hemorrhagic shock, which decreased ICP precisely and improved cerebral oxygen metabolism.[