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目的探讨7.5%高渗盐水对颅脑损伤患者脑水肿及预后的影响。方法将100例颅脑损伤患者随机分为2组:高渗盐水治疗组(hype rtonic saline solution treatment,HTS组)和甘露醇治疗组(mannitolt reatment,M组)。HTS组静脉滴注7.5%高渗盐水2mL/kg,M组静脉滴注甘露醇250mL,均为1次/8h,连续7d。在治疗前及治疗后3、7、14d分别复查头CT,并依据头CT显示脑水肿最大层面的长×宽测算脑水肿的面积,表示脑水肿的程度,观察其变化;治疗前及治疗后14d后对患者进行格拉斯哥昏迷(glasgow coma scale,GCS)评分。结果 2组患者伤后脑水肿均逐渐加重而至第7天达高峰期,第14天脑水肿均明显减轻,但在第7天脑水肿高峰期HTS组患者脑水肿的程度明显低于M组(P<0.01);高渗盐水治疗期间未发现明显不良反应。治疗14 d后HTS组和M组患者GCS评分均有明显改善(P<0.05),但2组患者同期GCS评分差异无统计学意义(P>0.05)。结论 7.5%高渗盐水可以减轻颅脑损伤患者脑水肿,并能改善其预后,无明显不良反应。
Objective To investigate the effect of 7.5% hypertonic saline on brain edema and prognosis in patients with craniocerebral injury. Methods 100 cases of craniocerebral injury were randomly divided into two groups: hypertensive saline solution treatment group (HTS group) and mannitol treatment group (mannitolt reatment, M group). In HTS group, 7.5% hypertonic saline 2 mL / kg was intravenously instilled, and M group was intravenously administered with 250 mL of mannitol once a day for 8 days for 7 days. Head CT was reviewed before treatment and at 3, 7 and 14 days after treatment, and the area of cerebral edema was calculated according to the length and width of the largest level of brain edema on the head CT. The degree of cerebral edema was expressed and the changes were observed. Before and after treatment Patients were scored on a glasgow coma scale (GCS) 14 days later. Results The post-traumatic cerebral edema in both groups gradually increased to reach the peak on the 7th day, and the cerebral edema on the 14th day were significantly reduced. However, on the 7th day, the brain edema in the HTS group was significantly lower than that in the M group P <0.01). No significant adverse reactions were found during hypertonic saline treatment. After 14 days of treatment, the GCS scores of HTS group and M group were significantly improved (P <0.05), but the GCS scores of the two groups had no significant difference (P> 0.05). Conclusion 7.5% hypertonic saline can relieve cerebral edema in patients with craniocerebral injury and improve prognosis without obvious adverse reactions.