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目的探讨严重脑挫裂伤脑疝患者行开颅大骨瓣减压围手术期应用大剂量甘露醇联合甲强龙控制颅内压的疗效。方法对严重脑挫裂伤脑疝患者,就诊时即予20%甘露醇250～375 ml快速静脉滴注后再应用生理盐水100ml+甲强龙500 mg静脉滴注,接着再次应用20%甘露醇250 ml快速静脉滴注。第1,2次甘露醇均于2～3 h内用完,部分患者第2次可在术中去除骨瓣硬膜切开前半小时应用。随机选择35例同病种病例,围手术期单独应用20%甘露醇250 ml快速静脉滴注,并进行对比分析。结果经应用该方法后35例患者中,除1例高龄患者出现恶性脑肿胀压力无法控制后,其他病例术中脑压均控制良好,创造良好手术时机,促进手术顺利进行;术后常规脱水补液,维持有效循环量,监测肾功能变化,未出现急性肾功能衰竭病例;效果明显优于对照组(P﹤0.01),差异具统计学意义。结论大剂量(8～10 ml/kg,平均8.9 ml/kg)甘露醇联合甲强龙在严重脑挫裂伤脑疝患者围手术期应用,能有效控制颅高压,创造手术时机,效果好,未出现急性肾功能衰竭现象。
Objective To investigate the curative effect of high dose mannitol combined with methylprednisolone on intracranial pressure during perioperation of patients with severe cerebral contusion and hernia. Methods Severe brain contusion brain herniation patients treated with rapid infusion of 250 to 375 ml of 20% mannitol intravenously followed by intravenous infusion of 100 ml normal saline 500 mg methylprednisolone followed by 20% mannitol 250 ml rapid intravenous infusion. The first and second mannitol were used up within 2 ~ 3 h, some patients can be removed during the second half of the bone flap dural half an hour before application. 35 cases were randomly selected with the same disease cases, perioperative application of 20% mannitol 250 ml rapid intravenous infusion, and comparative analysis. Results After the method was applied to 35 patients, except one case of elderly patients with malignant brain swelling pressure can not be controlled, intraoperative cerebral pressure were well controlled in other cases, to create a good opportunity for surgery to promote the smooth operation of the postoperative routine dehydration rehydration, Maintenance of effective circulation, monitoring of renal function changes, no cases of acute renal failure cases; the effect was significantly better than the control group (P <0.01), the difference was statistically significant. Conclusion High dose (8-10 ml / kg, average 8.9 ml / kg) of mannitol combined with methylprednisolone can effectively control the intracranial hypertension in patients with severe brain contusion and cerebral hernia, create the operation opportunity and have good effect, No acute renal failure occurred.