摘要目的 探讨高渗盐复合液(高渗盐水羟乙基淀粉 HSH)在颅脑损伤合并低血容量性休克中的疗效及对颅内压(ICP)的影响.方法 为前瞻、对照性研究.选择2007年9月至2008年7月入住广东省人民医院ICU及脑外科颅脑损伤且平均动脉压(MAP)低于60 mmHg的患者60例,其中男51例,女9例,年龄18～69岁,平均(41.5±9.5)岁.排除标准:年龄<18岁或>70岁的患者;孕妇、月经期妇女;严重肝肾功能障碍;高血压、冠心病、糖尿病病史者;大出血未止住;治疗前数小时内应用过其它血管活性物质;受伤超过24 h者;脑死亡.随机分成3组(每组加例),3组年龄性别构成具可比性,分别以平衡液(平衡液LR组)500 ml、5%氯化钠(高渗盐水HIS组)4 ml/kg、HSH(HSH组)4 ml/kg进行液体复苏,记录复苏前及复苏30、60、120 min时的血压、呼吸、心率、尿量等,抽静脉血检测凝血功能、电解质,应用颅内压无创检测分析仪测量ICP.采用SPSS 13.0统计软件进行统计学处理数据,各组复苏前后指标应用重复测量设计资料的方差检验分析,组间比较应用(one_way analysis of variance ANOVA)检验分析,以P<0.05为差异有统计学意义.结果 复苏30 min时HIS、HSH组MAP即恢复到60 mmHs以上,且ICP降低10%以上;60 min时LR组MAP恢复到60mmHg以上,但ICP无降低.120 min时HSH提高MAP和降低ICP的作用优于LR、HIS组,差异有统计学意义(F=18.43,8.99,P<0.05);各组用药前后实验室检测指标无明显变化(P>0.05).结论 在颅脑损伤合并低血容量性休克的救治中HSH复苏效果及降低颅内压作用显著且持久,有利于保护脑功能.

abstractsObjective To investigate the effect of hypertonic sodium chloride hydroxyethyl 40 injection (HSH)on craniocerebral injury accompanied with hypovolemic shock and ICP.Method Sixty patients suffering from craniecerebral injury accompanied with the hypovolemic shock and admitted to ICU and Neurosurgical Department of Guang dong General Hospital from September 2007 to June 2008,were chosen into the study prospectively.Those who was younger than 18years or older than 70 years,and those who were pregnant or meustruous women,or serious hepatic and renal insufficiency,hypertension,coronaxy artery disease,diabets mellitue,uncontrolled bleeding,brain death,erc were excluded.The patients were randomly divided into 3 groups.Each group included 20 patients and they were resuscitated with LR(500 ml),HIS(4 ml/kg)and HSH(4 ml/kg)respectively.The changos of blood pressure,laboratory examination indices and ICP Were detected before and at 30,60,120 minutes after resuscitation.Results MAP raised over 60 mmHg and ICP declined 10%within 30 min in HIS and HSH groups.The effect of HSH on the improving of blood pressure and the reduction of ICP wag more obvious than that of LR and HIS at 120 minutes(F=18.43,8.99,P<0.05)after resuscitation.There were no obvious oboes of the laboratory examination indices after resuscitation.Conclusions The themputic effect of HSH on ICP and MAP in craniocerebral injury accompanied with hypovolemic shock is obvious and lasting,which would be beneficial to the protection of cerebral function.