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作者自1992年1月至1995年7月对1379例颅脑重症和开颅手术病例进行血清渗透压值(简称血渗值)动态监测共2843人次。利用自身对比摒弃干扰因素,得到以下结果:(1)血渗值与颅内压以及甘露醇剂量相关研究,表明血渗值升高与甘露醇剂量呈正相关,与颅内压降低呈负相关。输注甘露醇后血渗值比正常上限升高15～20mOsm/kgH_2O时,甘露醇剂量为最合理剂量;(2)血渗值在用药后升高20～30mOsm/kgH_2O,超过300mOsm/kgH_2O时并发症增加,达到320mOsm/kgH_2O为急性肾衰临界值;330mOsm/kgH_2O为非酮症高渗高糖昏迷警戒值。作者还就甘露醇的作用时间和两种减量或停药方式的优缺点以及纠正高渗的安全速度进行讨论,指出血渗值和颅内压动态监测可有效降低高渗性并发症的发生和死亡率,对维持液体容量和解决脱水与补液矛盾、防治高渗性并发症以及估计预后有重要价值。
Authors from January 1992 to July 1995 of 1379 cases of craniocerebral disease and craniotomy cases of serum osmolarity (referred to as blood leakage) dynamic monitoring of a total of 2843 people. The use of their own contrast to get rid of interference factors, the following results: (1) blood leaking value and intracranial pressure and mannitol dose-related studies showed that elevated blood osmolality and mannitol dose was positively correlated with decreased intracranial pressure was negatively correlated. Mannitol dose was the most reasonable dose when blood leakage increased 15-20 mOsm / kgH2O than the normal upper limit after infusion of mannitol; (2) Blood osmolarity increased by 20-30 mOsm / kgH2O after administration, and over 300 mOsm / kgH2O Complications increased to 320mOsm / kgH_2O for the critical value of acute renal failure; 330mOsm / kgH_2O non-ketotic hyperosmolar hyperglycemic coma alert value. The authors also discussed the duration of action of mannitol and the advantages and disadvantages of two reduction or withdrawal methods and the safety speed of correcting hypertonicity. It is pointed out that the blood leakage and dynamic monitoring of intracranial pressure can effectively reduce the occurrence of hypertonic complications And mortality, the maintenance of liquid volume and to resolve the contradiction between dehydration and fluid replacement, prevention and treatment of hypertonic complications and prognosis of great value.