高渗盐水和甘露醇在动脉瘤术后颅内高压中的应用

目的探讨3%高渗盐水(HS)和20%甘露醇(MT)在治疗蛛网膜下腔出血合并动脉瘤夹闭术后颅内压增高中的疗效。方法分析徐州医科大学附属医院神经外科2017年4月至2018年11月收治的蛛网膜下腔出血合并动脉瘤行动脉瘤夹闭术后颅内压增高患者28例,在持续颅内压监测下,随机接受等渗剂量的3%HS与20%MT进行降颅压治疗,监测患者颅内压、平均动脉压(MAP)及中心静脉压(CVP),并记录有效颅内压降低持续时间、颅内压最大下降幅度及时间、用药前及用药后1、3 h血钠浓度及血浆渗透压。结果经3%HS和20%MT治疗后颅内压均迅速下降,与用药前比较差异具有统计学意义(P<0.05);两者颅内压降低持续时间及颅内压下降幅度比较差异无统计学意义(P>0.05)。两种药使用后MAP比较差异均无统计学意义(P>0.05)。与治疗前比较,20%MT治疗后CVP升高,差异有统计学意义(P<0.05);3%HS治疗后CVP变化差异无统计学意义(P>0.05)。20%MT治疗后患者血钠下降,3%HS治疗后血钠上升,变化差异有统计学意义(P<0.05),20%MT与3%HS治疗后患者血浆渗透压先上升后下降,变化差异均有统计学意义(P<0.05)。结论3%HS和20%MT在降低颅内压起效时间、最大下降幅度、有效持续时间上无明显差异,均可安全有效地治疗蛛网膜下腔出血合并动脉瘤夹闭术后颅内压增高患者。

Application of hypertonic saline and mannitol in intracranial hypertension after aneurysm surgery

Objective To investigate the effect of 3%hyperosmotic saline(HS)and 20%mannitol(MT)in treating intracranial hypertension after surgery for subarachnoid hemorrhage combined with aneurysm.Methods The 28 patients who had intracranial hypertension after aneurysm clipping for treatment of subarachnoid hemorrhage combined with aneurysm were admitted into the affiliated hospital of Xuzhou medical university from April 2017 to November 2018.Under the monitoring of continuous intracranial pressure(ICP),they were randomly treated with isoosmotic dose of 3%HS and 20%MT to reduce intracranial pressure.Intracranial pressure(ICP),mean arterial pressure(MAP)and central venous pressure(CVP)were monitored,and the duration of effective intracranial pressure reduction,maximum decrease of intracranial pressure,blood sodium concentration and plasma osmotic pressure before treatment and 1 hour,3 hours after treatment were observed.Results ICP decreased rapidly after 3%HS and 20%MT treatment,and the difference was statistically significant compared with that before treatment(P<0.05).There was no significant difference in the duration of effective intracranial pressure reduction and the range of ICP decrease between the two methods(P>0.05).There was no significant difference in the MAP(P>0.05).The CVP increased after 20%MT treatment,and the difference was statistically significant compared with that before treatment(P<0.05);but the change of CVP after 3%HS treatment was not statistically significant(P>0.05).The blood sodium decreased after 20%MT treatment.On the contrary,the blood sodium increased after 3%HS treatment,and the change was statistically significant(P<0.05).The plasma osmotic pressure increased first and then decreased after 20%MT and 3%HS treatment,and the changes were statistically significant(P<0.05).Conclusion There was no significant difference in the onset time,maximum decrease range and effective duration of intracranial pressure between 3%HS and 20%MT treatment.Both of them could be safely and effectively used in patients with intracranial hypertension after aneurysm clipping for treatment of subarachnoid hemorrhage combined with aneurysm.