高渗盐复合液用于颅脑外伤合并失血性休克的治疗

目的研究高渗盐溶液（7．5％氯化钠／6％右旋糖酐液，HSD）及高渗盐复合液（高渗氯化钠／羟乙基淀粉40注射液，霍姆）用于颅脑外伤合并失血性休克患者的治疗效果。方法将93名颅脑外伤合并失血性休克的患者随机分为2组，为霍姆组（HH组）和HSD组，分别使用霍姆和HSD进行液体复苏，于To（入院时）、15分钟（L）、30分钟（B）、60分钟（B）不同时间点监测记录平均动脉压（MAP）、心率（HR）、尿量（VOL）变化；监测人院时及输液60分钟后的血红蛋白（Hb）、红细胞压积（HCT）、GCS评分；记录早期复苏时间、术前总输液量、胶体液比例；记录入院后24小时死亡率、1周死亡率。结果输液后30分钟、60分钟，HH组的平均动脉压显著大于HsD组（P≮O．05）。输液60分钟，HH组的心率显著小于HSD组（P〈0．05）。在15分钟、30分钟、60分钟，HH组的尿量显著多于HSD组（P〈0．05）。HH组患者60分钟后测得HCT与Hb均较人院时有显著下降（P〈0．05）。HSD组60分钟后的HCT与入院时无显著性差异（P〉O．05），而输液60分钟后的Hb显著低于入院前（P〈O．05）。GCS评分，HH组液体复苏前后有显著性差异（P〈O．05），而HSD组前后却没有显著差异。液体复苏60分钟后的GCS值HH组显著大于HSD组（RO．05）。HH组手术前平均输液量显著少于HSD组fP〈0，05）。人院24小时内及1周内，HH纽死亡率均稍低于HSD组死亡率，但无显著差异（P〉O．05）。结论在颅脑外伤合并创伤失血性休克的情况下，补充高渗盐复合液不仅能更快的纠正组织低灌注，保护重要心、脑、肺等脏器，降低颅内压，还能减少输液量。

Hypertonic saline solution in treatment of traumatic brain injury combined with hemorrhagic shock

Objective To compare the clinical efficacy between hypertonic saline-dextran （HSD, 7.5% hypertonic saline plus 6% dextran70） and Huomu solution （HH, Hydroxyethyl Starch 40 Sodium Chloride Solution, 4.2% hypertanic saline plus 7.6% hydroxyethyl starch40） in the fluid re- suscitation of traumatic brain injury combined with hemorrhagic shock, Methods 93 patients with traumatic brain injury and hemon＇hagic shock were randomly divided into the HSD resuscitation group or HH resuscitation group, then recorded the mean arterial pressure （MAP）, heart rate （HR）, urine volume （VOL） at the time of admission （To）, 15min （T1）, 30rain （T2）, 60rain （T3）, after admission. Recorded Hemoglobin （Hb）, hematocrit （HCT）, GCS score at the time of admission and 60min after fluid resuscitation, and recorded the early recovery time, the total fluid volume in the preoperative resuscitation, the mortality 24 hours and one week after admission as well. Results The MAP in HH group was significantly higher than HSD group at T2 and T3 （P〈0.05）, the HR in HH group was significantly lower than HSD group at T3 （P〈0.05）, the VOL in HH group was significantly more than HSD group at T1, T2and 313 （P〈0.05）. The GCS score significantly increased in HH group （P〈0.05） while the HSD group not. The total fluid volume used pre-operation in HH was significantly less than HSD group （P〈0.05）, the mortality 24 hours and one week after admission had no sig- nificant difference between HI-I and HSD group. Conclusion Huomu Solution （HH） could be the primary preferred solution for the emergency fluid resuscitation of traumatic brain injury combined with hemorrhagic shock.