地塞米松和甘露醇合用对急性重症脑血管病脑保护作用的疗效分析

许春奇; 钟平; 程仁立; 张友红; 扬洋

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

地塞米松和甘露醇合用对急性重症脑血管病脑保护作用的疗效分析

许春奇 , 钟平 , 程仁立 , 张友红 , 扬洋

文章导航 > 蚌埠医学院学报 > 2012, 36 > 1: (46-47)

引用本文:

Citation:

地塞米松和甘露醇合用对急性重症脑血管病脑保护作用的疗效分析

1.
安徽省宿州市立医院急诊重症监护室, 234000

作者简介: 许春奇（ 1975 - ）,男，主治医师。

基金项目:

Clinical study of the effect of dexamethasone with mannitol on acute severe cerebrovascular disease

1.
Emergency Intensive Care Unit of Clinical, Suzhou Municipal Hospital, Suzhou Anhui 234000, China

摘要: 目的：探讨地塞米松（DXM）和甘露醇合用对急性重症脑血管病脑保护作用的疗效。方法：将符合诊断条件的患者分为治疗组和对照组，治疗组在予甘露醇等脱水、降颅压、保护脑细胞等常规治疗的同时，在20%甘露醇中加入DXM 3 mg，每4～6 h静脉滴注1次，DXM 3 d后逐渐减量，持续应用3～5 d，最长不超过7 d；对照组只行常规治疗，同时对所有入选者每小时监测1次颅内压（ICP），持续监测到ICP恢复正常或死亡为止，并且分别在第1、3、6个月跟踪问卷调查，再次进行GCS评分。结果：入院时2组患者ICP比较差异无统计学意义（P；0.05）。治疗后，治疗组ICP恢复正常多集中在2～4 d，而对照组多集中在3～7 d，第3、4天ICP恢复正常例数比较差异有统计学意义（P＜0.01）。2组并发症比较差异均无统计学意义（P＞0.05）。2组急性期共死亡10例，治疗组3例，病死率6%；对照组7例，病死率14%，差异无统计学意义（P＞0.05）。3次跟踪问卷调查并进行GCS评分，治疗组症状好转例数较对照组多（P＜0.05），新增死亡7例中，治疗组3例。结论：在脑血管病中，DXM和甘露醇合用对减轻脑水肿、降低颅内压和促进神经功能恢复的脑保护作用更强，且不增加其并发症和病死率。
- 脑血管病 /
- 地塞米松 /
- 甘露醇 /
- 脑保护作用
Abstract: Objective:To investigate the protective effect of dexamethasone(DXM) with mannitol on acute severe cerebrovascular disease.Methods:patients met the diagnostic criteria were divided into treatment groupand control group.In the treatment group,3 mg DXM 20% mannitol was given intravenously per 4-6 hours,continuous application of 3-5 days,a maximum of 7 days on the basis of routine treatment.The control grouponly received routine treatment.At the same time monitoring intracranial pressure (ICp) was monitered once per hour,until ICpreturned to normal or the patients died.Then tracked them after the first survey at 1,3,6 months respectively,made GCS score again.Results:There was no significant difference in ICpon admission between the two groups(P＞0.05).In the treatment group,ICpreturned to normal in 2-4 days,but in the control group,more concentrated 3-7 days.Compared the number of cases,ICpreturned to normal at the 3,4 days,the difference was statistically significant (P＜0.01).The complications between the two goups showed no statistically significance(P＞0.05).Ten cases were died in the acute phase in the two groups,the treatment grouphad 3 cases,mortality rate was 6%.The control grouphad 7 cases,mortality rate was 14%.In the treatment group,the number of cases with symptoms improved was more than the control group(P＜0.05) in GCS score.The treatment grouphad 3 cases in 7 new deaths.Conclusions:DXM with mannitol can reduce more brain edema,more intracranial pressure and promote the recovery of neurological function than control groupin acute cerebrovascular disease,and does not increase the morbidity and mortality.
- cerebrovascular disease /
- dexamethasone /
- mannitol /
- brain protection

[1]	董世节,刘金英,魏建功,等.持续腰大池引流脑脊液加鞘内注入地塞米松治疗重型颅脑损伤的研究[J].齐齐哈尔医学院学报,2009,30(14):1681-1683.
[2] 吴慧,赵东.大剂量地塞米松治疗中重度颅脑损伤致脑水肿疗效观察[J].中国临床研究,2005,18(01):29-30.
[3] 罗祖明,汪凯.脑血管疾病[M]//贾建平.神经病学.6 版.北京:人民出版社,2008:171.
[4] 高旭光,李坤成,陈生弟等主译.神经病学[M].沈阳:辽宁科学技术出版社,2002:203-213.
[5] 李香迎,张成刚,张斌,等.局部激素缓释片应用对脑内血肿清除后脑水肿的影响[J].中华神经外科疾病研究杂志,2007,6(1):517-518.
[6] 范玉兰,卢瑛,赵姝行,等.脑脊液置换鞘内注射地塞米松治疗老年人脑室内出血疗效观察[J].中国误诊学杂志,2005,5(3):517-518.
[7] 江厚芳.脑脊液置换及鞘内注入地塞米松治疗蛛网膜下腔出血的疗效分析[J].安徽医药,2005,9(8):581-582.
[8] 江荣.小儿颅内出血的临床探讨[J].蚌埠医学院学报,2000,25(6):404-405.
[9] Gernt ST,Rodriguez JL,Pawli JW,et al.Consequences of highdose steroid therapy for acute spinal cord injury[J].J Trauma,1997,43(8):6593.

[1]	孔亮 , 王引明 , 桂树华 . 甘露醇对脑出血患者脑血流状况的影响. 蚌埠医学院学报, 2012, 36(6): 679-680.
[2]	董瑞剑 . 丁苯酞软胶囊治疗脑小血管病伴认知功能损害病人的临床疗效及对血流灌注的影响. 蚌埠医学院学报, 2018, 43(3): 313-315. doi: 10.13898/j.cnki.issn.1000-2200.2018.03.010
[3]	廖圣恺 , 徐涛 , 卢保全 . 平阳霉素联合地塞米松注射治疗口腔颌面部海绵状血管瘤. 蚌埠医学院学报, 2005, 30(1): 33-34.
[4]	刘正东 . 急性脑血管病机械通气患者院内病死的危险因素分析. 蚌埠医学院学报, 2013, 37(8): 959-961.
[5]	吴章淑 . 循证护理对脑血管病介入术前后不良情绪及生活质量的影响. 蚌埠医学院学报, 2015, 40(10): 1434-1436.
[6]	陶如华 , 关畅 , 沈传业 . 加温甘露醇注射液对静脉留置针留置时间的影响. 蚌埠医学院学报, 2014, 39(8): 1149-1150.
[7]	李敏 , 王桂芳 . 两种方法外敷治疗甘露醇所致静脉炎疗效观察. 蚌埠医学院学报, 2009, 34(11): 1036-1037.
[8]	许娟娟 , 李云云 , 屈洪党 . 急性脑血管病诱发多器官功能障碍综合征研究进展. 蚌埠医学院学报, 2017, 42(8): 1151-1153. doi: 10.13898/j.cnki.issn.1000-2200.2017.08.046
[9]	胡庆玲 . 口服甘露醇注射液代替肥皂水灌肠的观察. 蚌埠医学院学报, 2006, 31(6): 671-672.
[10]	傅毅 , 陈生弟 , 马飞月 . 脑血管病患者血浆同型半胱氨酸浓度及相关因素分析. 蚌埠医学院学报, 2004, 29(2): 151-153.
[11]	卢剑华 , 刘丽 , 陈强 . 阿扎司琼联合地塞米松预防妇科术后恶心呕吐疗效观察. 蚌埠医学院学报, 2012, 36(7): 822-824.
[12]	唐燕青 . 金黄散联合地塞米松外敷预防化疗性静脉炎疗效观察. 蚌埠医学院学报, 2010, 35(11): 1179-1180.
[13]	郑立东 , 杨松保 . 地塞米松对吗啡、布比卡因、氟哌利多术后连续硬膜外镇痛的影响. 蚌埠医学院学报, 2004, 29(5): 446-447.
[14]	严明 , 华春媛 , 张梅 , 李祖阁 . 地塞米松联合氟哌利多预防腹腔镜胆囊切除术后恶心、呕吐. 蚌埠医学院学报, 2009, 34(1): 34-36.
[15]	陆宇淼 , 曹德菁 , 周晓燕 . 地塞米松防治根管治疗期间痛的疗效观察. 蚌埠医学院学报, 2005, 30(4): 323-325.
[16]	李小双 , 刘丽 , 罗菲菲 , 解启莲 . 小剂量地塞米松对脓毒症小鼠 CD11b⁺Gr-1⁺髓源抑制性细胞的影响. 蚌埠医学院学报, 2015, 40(6): 712-715. doi: 10.13898/j.cnki.issn.1000-2200.2015.06.004
[17]	侯丽 , 石明丽 , 王玲 , 汪伟 . 地塞米松联合山莨菪碱局部湿敷对浅静脉留置针处静脉炎的预防效果观察. 蚌埠医学院学报, 2009, 34(6): 541-542.
[18]	李志杰 , 杜昌国 . 联合应用地塞米松、甲氧氯普胺、昂丹司琼预防乳腺癌化疗呕吐效果观察. 蚌埠医学院学报, 2013, 37(4): 440-442.
[19]	张洪涛 , 麻宏亮 , 李强 . 格拉司琼与甲氧氯普安并小剂量地塞米松治疗顺铂为主的化疗所致的迟缓呕吐. 蚌埠医学院学报, 2010, 35(9): 928-929.
[20]	傅磊 , 沈磊 , 卞建军 , 李亮 , 苏玉璇 , 左金曼 , 孟美丽 , 陆尧 , 葛书亚 , 张伊莉 . 重组人血小板生成素联合大剂量地塞米松对原发性ITP病人Treg细胞及Th1、Th2细胞的影响. 蚌埠医学院学报, 2021, 46(7): 858-862. doi: 10.13898/j.cnki.issn.1000-2200.2021.07.005

点击查看大图

计量

文章访问数: 2123
HTML全文浏览量: 265
PDF下载量: 510
被引次数: 0

地塞米松和甘露醇合用对急性重症脑血管病脑保护作用的疗效分析

作者简介: 许春奇（ 1975 - ）,男，主治医师。

1. 安徽省宿州市立医院急诊重症监护室, 234000

收稿日期: 2011-05-23
网络出版日期: 2012-01-15

基金项目:

关键词:

摘要: 目的：探讨地塞米松（DXM）和甘露醇合用对急性重症脑血管病脑保护作用的疗效。方法：将符合诊断条件的患者分为治疗组和对照组，治疗组在予甘露醇等脱水、降颅压、保护脑细胞等常规治疗的同时，在20%甘露醇中加入DXM 3 mg，每4～6 h静脉滴注1次，DXM 3 d后逐渐减量，持续应用3～5 d，最长不超过7 d；对照组只行常规治疗，同时对所有入选者每小时监测1次颅内压（ICP），持续监测到ICP恢复正常或死亡为止，并且分别在第1、3、6个月跟踪问卷调查，再次进行GCS评分。结果：入院时2组患者ICP比较差异无统计学意义（P；0.05）。治疗后，治疗组ICP恢复正常多集中在2～4 d，而对照组多集中在3～7 d，第3、4天ICP恢复正常例数比较差异有统计学意义（P＜0.01）。2组并发症比较差异均无统计学意义（P＞0.05）。2组急性期共死亡10例，治疗组3例，病死率6%；对照组7例，病死率14%，差异无统计学意义（P＞0.05）。3次跟踪问卷调查并进行GCS评分，治疗组症状好转例数较对照组多（P＜0.05），新增死亡7例中，治疗组3例。结论：在脑血管病中，DXM和甘露醇合用对减轻脑水肿、降低颅内压和促进神经功能恢复的脑保护作用更强，且不增加其并发症和病死率。

English Abstract

Clinical study of the effect of dexamethasone with mannitol on acute severe cerebrovascular disease

1. Emergency Intensive Care Unit of Clinical, Suzhou Municipal Hospital, Suzhou Anhui 234000, China

Received Date: 2011-05-23
Available Online: 2012-01-15

Abstract: Objective:To investigate the protective effect of dexamethasone(DXM) with mannitol on acute severe cerebrovascular disease.Methods:patients met the diagnostic criteria were divided into treatment groupand control group.In the treatment group,3 mg DXM 20% mannitol was given intravenously per 4-6 hours,continuous application of 3-5 days,a maximum of 7 days on the basis of routine treatment.The control grouponly received routine treatment.At the same time monitoring intracranial pressure (ICp) was monitered once per hour,until ICpreturned to normal or the patients died.Then tracked them after the first survey at 1,3,6 months respectively,made GCS score again.Results:There was no significant difference in ICpon admission between the two groups(P＞0.05).In the treatment group,ICpreturned to normal in 2-4 days,but in the control group,more concentrated 3-7 days.Compared the number of cases,ICpreturned to normal at the 3,4 days,the difference was statistically significant (P＜0.01).The complications between the two goups showed no statistically significance(P＞0.05).Ten cases were died in the acute phase in the two groups,the treatment grouphad 3 cases,mortality rate was 6%.The control grouphad 7 cases,mortality rate was 14%.In the treatment group,the number of cases with symptoms improved was more than the control group(P＜0.05) in GCS score.The treatment grouphad 3 cases in 7 new deaths.Conclusions:DXM with mannitol can reduce more brain edema,more intracranial pressure and promote the recovery of neurological function than control groupin acute cerebrovascular disease,and does not increase the morbidity and mortality.