- 學位論文
探討傳統利尿劑及3%Nacl對於頭部外傷之病人顱內壓降低情形與預後影響
Prognosis and decrease intracranial pressure level of patient with traumatic brain injury treated with either traditional diuretics or 3% NaCl
摘要
研究目的:對於創傷性腦損傷(Traumatic brain injury, TBI)個案，除外科手術為最有效及快速降低顱內壓(Intracranial pressure, ICP)之方法外，急性期的後續照護中，藥物治療避免腦部二次損傷尤其重要，故對於不同藥物治療因創傷性腦損傷導致腦水腫病患的成效，有其探討之必要性。研究方法:此研究為回顧性的研究，收案對象為南部某區域醫院，外科加護病房之創傷性腦損傷(TBI)之個案，探討hyperosmolarity fluid(以下簡稱:HOSM)併用傳統的利尿劑(本研究使用Furosemide)或高滲透壓性鹽水(本研究使用3% NaCl)，對於創傷性腦損傷個案降低顱內壓(ICP)的成效以及病人之預後狀況(包含:住院天數、呼吸器依賴情形)。研究結果:收案人數:98人，對於利用3%NaCl及HOSM的組別共42位(42.8%)，Furosemide及HOSM的組別有56位(57.2%)。利用兩組樣本T檢定，探討兩組的住院天數，前者平均住院天數14.07±5.91，後者18.16±7.18，P值<0.001；呼吸器脫離之情形，前者29位(69%)成功脫離呼吸器，後者有27位(48%)，P值<0.001。結論:創傷性腦部損傷之個案，併用3%NaCl及HOSM在住院天數、呼吸器依賴及存活之情形有較好的結果。
並列摘要
Purpose: For cases with traumatic brain injury (TBI), decompression is the most effective and rapid method for reducing intracranial pressure (ICP).It is necessary to explore the outcomes between different medical treatments of traumatic brain injury because prevention of secondary brain injury is paramount in the acute phase. Methods: We conducted a retrospective study about cases with traumatic brain injury in a surgical intensive care unit of a metropolitan hospital in southern Taiwan. The decrease in intracranial pressure and prognosis, including duration of stay and ventilator dependence, were evaluated in patients with traumatic brain injury treated with hyperosmolar fluids (HOSM) combined with either a diuretic (furosemide) or hypertonic saline (3% Sodium chloride, NaCl). Result: A total of 98 cases were evaluated, with 42 (42.7%) cases treated with 3%NaCl and HOSM and 56 (57.3%) cases treated with furosemide and HOSM. A T-test was applied to evaluate the results between these two groups. In length of stay, the 3% NaCl and HOSM group was 14.07 ± 5.91 days and the furosemide and HOSM group was 18.16 ± 7.18( p value < 0.001). With 3% NaCl and HOSM, 29 cases (69%) were weaned from the ventilator successfully and with furosemide and HOSM, 27 cases (48%) were weaned from the ventilator successfully. (p value < 0.001) Conclusion: In cases with traumatic brain injury, combined treatment with hypertonic saline and hyperosmolar fluids improves the length of stay, ventilator dependence, and survival rate compared with combined furosemide and hyperosmolar fluid treatment.