目的: 比较两种浓度(3%和10%)高渗盐水(hypertonic saline, HTS)序贯20%甘露醇(mannitol, MT)治疗急性大面积脑梗死后颅高压的疗效。方法: 选取2020年8月-2023年2月桂林市中医医院脑病科住院部诊治的急性大面积脑梗死合并颅内高压患者40例,按照随机数字表法分为两组,每组20例。治疗组(A组)使用10%HTS 60 mL与20%MT 125 mL交替静点进行降颅压治疗(具体频次参照颅内压调整),对照组(B组)使用3%HTS 130 mL与20%MT 125 mL序贯治疗。连续监测两组患者用药前后颅内压(intracranial pressure, ICP)、平均动脉压(mean arterial pressure, MAP)和中心静脉压(central venous pressure, CVP),并根据ICP和MAP计算相应的脑灌注压(cerebral perfusion pressure, CPP)。记录入组患者有效降低颅内压的持续时间、颅内压最大降幅及持续时间,记录用药前和用药后2 h、6 h的血钠值和血浆渗透压。结果: 共入组40例,完成36例,脱落4例。统计结果显示,在不同的时间段,两组用药前后ICP、MAP、CPP、血钠及渗透压比较差异均有统计学意义(P＜0.05),用药2 h、6 h后,A组的ICP低于B组(P＜0.05),MAP、CVP、CPP、血钠及血浆渗透压均高于B组(P＜0.05)。在用药2 h后ICP降低最明显(P＜0.05),血钠区间在150~160 mmol/L之间ICP降低最显著(P＜0.05)。结论: 3%和10%的HTS均可有效降低急性大面积脑梗死患者的ICP,但10%的HTS效果更明显,降颅内压效果更持久,对血钠的影响较小,值得临床推广。

Objective: To compare the efficacy of 3% hypertonic saline(HTS) and 10% HTS combining with 20% mannitol(MT) in the treatment of high cranial pressure after acute massive cerebral infarction. Methods: A total of 40 patients with acute massive cerebral infarction complicated with intracranial hypertension diagnosed and treated by the inpatient Department of Encephalopathy, Guilin Hospital of Traditional Chinese Medicine from 2020 to 2023 were selected in this study. Selected patients were divided into two groups(20 patients in each group) according to random number table method. The treatment group(groupA) was treated with 10% HTS 60 mL and 20% MT 125 mL at alternate static points for cranial pressure reduction(the specific frequency was referred to the adjustment of intracranial pressure), and the control group(groupB) was treated with 130 mL of 3% HTS and 125 mL of 20% MT sequentially. Intracranial pressure(ICP), mean arterial pressure(MAP) and central venous pressure(CVP) were continuously monitored before and after medication in both groups, and the corresponding cerebral perfusion pressure(CPP) was calculated according to ICP and MAP. The duration of effective reduction of intracranial pressure, the maximum reduction and duration of intracranial pressure in enrolled patients were recorded, and the blood sodium value and plasma osmotic pressure were recorded before, 2 and 6 hours after medication. Results: A total of 40 cases were enrolled, with 36 cases completed and 4 cases rejected. The statistical results showed that ICP, MAP, CPP, blood sodium and osmotic pressure were significantly different between the two groups before and after treatment in different periods(P＜0.05). After 2 and 6 h of medication, ICP in groupA was lower than that in groupB(P＜0.05), while MAP, CVP, CPP, sodium and plasma osmotic pressure were higher than those in the control group(P＜0.05). ICP was the most significantly decreased 2 h after treatment(P＜0.05), and ICP was the most significantly decreased in the range of 150 to 160 mmol/L of blood sodium(P＜0.05). Conclusion: 3% and 10% HTS can effectively reduce ICP in patients with acute large area cerebral infarction, but 10% HTS has more lasting effect on reducing intracranial pressure and less influence on blood sodium and internal environment, which is worthy of clinical promotion.