• 四川大學華西醫(yī)院ICU（成都610041）;

目的 　通過為1例創(chuàng)傷后顱內高壓患者循證制定降顱壓方案，剖析當前創(chuàng)傷后顱內高壓的最佳循證治療證據(jù)。
方法 　檢索Cochrane圖書館（2006年第2期）、MEDLINE（1981～2006.8）及CBMdisc（1978～2006.8）等數(shù)據(jù)庫，獲取并評價相關的系統(tǒng)評價和隨機對照試驗（RCT）。
結果 　關于藥物治療共檢索到2篇系統(tǒng)評價和8篇RCT；關于非藥物治療共檢索到6篇系統(tǒng)評價和2篇RCT。常規(guī)劑量的甘露醇不優(yōu)于高滲鹽水，卻優(yōu)于其他脫水降顱壓藥物。大劑量甘露醇較常規(guī)劑量更能降低病死率和嚴重并發(fā)癥，但缺乏大劑量甘露醇和高滲鹽水的比較研究。目前尚無有力證據(jù)支持非藥物療法作為常規(guī)使用。據(jù)此，結合患者意愿，我們對該患者在實施顱內血腫清除術前后行甘露醇大劑量治療，并收到良好效果。
結論 　對創(chuàng)傷后顱內高壓患者，甘露醇更能降低病死率和嚴重并發(fā)癥的發(fā)生。但尚需設計大樣本的隨機對照試驗來比較大劑量甘露醇和其他藥物的療效。非藥物療法作為一種輔助措施不被支持作為常規(guī)使用。

引用本文： 錢志成,康焰. 創(chuàng)傷后顱內高壓患者的循證治療. 中國循證醫(yī)學雜志, 2007, 07(2): 153-157. doi: 復制

版權信息： ?四川大學華西醫(yī)院華西期刊社《中國循證醫(yī)學雜志》版權所有，未經(jīng)授權不得轉載、改編

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2. Guyatt GH, R ennie D, Editors. The Evidence-Based Mdicine Working Group. Users’ Guides to the Mdical Literature: A Mannual for Evidence-based Clinical Practice. Chicago: AMA Press. 2002.
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8. Renaud V, Jacques A, Laurent T, et al. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Crit Care Med, 2003, 31: 1683–1687.
9. Biestro A, Alberti R, Galli R, et al. Osmotherapy for increased intracranial pressure: comparison between mannitol and glycerol. Acta neurochirurgica, 1997; 39(8): 725–732, discussion 732–733.
10. 錢東翔, 黃東健, 郭寶平, 等. 甘油果糖對腦損傷后血液流變學的影響. 中國臨床康復, 2004, 8(22): 4518–4520.
11. Schwartz M, Tator C, Rowed D, et al. The University of Toronto head injury treatment study: A prospective, randomized comparison of Pentobarbital and Mannitol. CAN-J-NEUROL-SCI, 1984; 11(4): 434–440.
12. Julio C, Giulio M, Kazuo O. Improving Clinical Outcomes from Acute Subdural Hematomas with the Emergency Preoperative Administration of High Doses of Mannitol: A Randomized Trial. Neurosurgery, 2001, 49: 864–871.
13. Julio C, Giulio M, Kazuo O. Major Clinical and Physiological Benefits of Early High Doses of Mannitol for Intraparenchymal Temporal Lobe Hemorrhages With Abnormal Pupillary Widening: a Randomized Trial. Neurosurgery, 2002, 51: 628–638.
14. Alderson P, Gadkary C, Signorini DF. Therapeutic hypothermia for head injury. The Cochrane Database of Systematic Reviews, 2006, Issue 2.
15. McIntyre LA, Fergusson DA, Hébert PC, et al. Prolonged therapeutic hypothermia after traumatic brain injury in adults: a systematic review. Database of Abstracts of Reviews of Effects, 2006, Issue 2.
16. Slade J, Kerr ME, Marion D. Effect of therapeutic hypothermia on the incidence and treatment of intracranial hypertension. The Journal of neuroscience nursing, 1999, 31(5): 264–269.
17. Marion DW, Obrist WD, Carlier PM, et al. The use of moderate therapeutic hypothermia for patients with severe head injuries: a preliminary report. Journal of neurosurgery, 1993, 79(3): 354–362.
18. Hayashi S, Inao S, Takayasu M, et al. Effect of early induction of hypothermia on severe head injury. Acta Neurochir, 2002, 81(Suppl): 83–84.
19. Bennett MH, Trytko B, Jonker B. Hyperbaric oxygen therapy for the adjunctive treatment of traumatic brain injury. The Cochrane Database of Systematic Reviews,2006, Issue 2.
20. Roberts I, Schierhout G. Hyperventilation therapy for acute traumatic brain injury. The Cochrane Database of Systematic Reviews,2006, Issue 2.
21. Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. The Cochrane Database of Systematic Reviews, 2006, Issue 2.
  1. 1. Qian DX, Huang DJ, Guo BP, et al. Effect of glycerol fructose on hemorrheologic properties after brain injury. Chinese Journal Of Clinical Rehabilitation, 2004, 8(22): 4518–4520.
  2. 2. Guyatt GH, R ennie D, Editors. The Evidence-Based Mdicine Working Group. Users’ Guides to the Mdical Literature: A Mannual for Evidence-based Clinical Practice. Chicago: AMA Press. 2002.
  3. 3. Phillips B, Ball C, Sackett D, et al. Levels of evidence and grades of recommendation. Available from: URL: http://www.cebm.net.
  4. 4. Wakai A, Roberts I, Schierhout G. Mannitol for acute traumatic brain injury. The Cochrane Database of Systematic Reviews, 2006, Issue 2.
  5. 5. Roberts I. Barbiturates for acute traumatic brain injury. The Cochrane Database of Systematic Reviews, 1999, Issue 3.
  6. 6. Battison C, Andrews PJ, Graham C, et al. Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury. Crit Care Med, 2005, 33: 196–202.
  7. 7. Afifi W, Abdallah I, Yosry M, et al. The effect of a single dose of 3% hypertonic saline versus mannitol 20% for treatment of brain oedema and intracranial hypertension in postoperative patients with supratentorial gliomata. Egyptian Journal of Anaesthesia, 2003, 19(4): 371–379.
  8. 8. Renaud V, Jacques A, Laurent T, et al. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Crit Care Med, 2003, 31: 1683–1687.
  9. 9. Biestro A, Alberti R, Galli R, et al. Osmotherapy for increased intracranial pressure: comparison between mannitol and glycerol. Acta neurochirurgica, 1997; 39(8): 725–732, discussion 732–733.
  10. 10. 錢東翔, 黃東健, 郭寶平, 等. 甘油果糖對腦損傷后血液流變學的影響. 中國臨床康復, 2004, 8(22): 4518–4520.
  11. 11. Schwartz M, Tator C, Rowed D, et al. The University of Toronto head injury treatment study: A prospective, randomized comparison of Pentobarbital and Mannitol. CAN-J-NEUROL-SCI, 1984; 11(4): 434–440.
  12. 12. Julio C, Giulio M, Kazuo O. Improving Clinical Outcomes from Acute Subdural Hematomas with the Emergency Preoperative Administration of High Doses of Mannitol: A Randomized Trial. Neurosurgery, 2001, 49: 864–871.
  13. 13. Julio C, Giulio M, Kazuo O. Major Clinical and Physiological Benefits of Early High Doses of Mannitol for Intraparenchymal Temporal Lobe Hemorrhages With Abnormal Pupillary Widening: a Randomized Trial. Neurosurgery, 2002, 51: 628–638.
  14. 14. Alderson P, Gadkary C, Signorini DF. Therapeutic hypothermia for head injury. The Cochrane Database of Systematic Reviews, 2006, Issue 2.
  15. 15. McIntyre LA, Fergusson DA, Hébert PC, et al. Prolonged therapeutic hypothermia after traumatic brain injury in adults: a systematic review. Database of Abstracts of Reviews of Effects, 2006, Issue 2.
  16. 16. Slade J, Kerr ME, Marion D. Effect of therapeutic hypothermia on the incidence and treatment of intracranial hypertension. The Journal of neuroscience nursing, 1999, 31(5): 264–269.
  17. 17. Marion DW, Obrist WD, Carlier PM, et al. The use of moderate therapeutic hypothermia for patients with severe head injuries: a preliminary report. Journal of neurosurgery, 1993, 79(3): 354–362.
  18. 18. Hayashi S, Inao S, Takayasu M, et al. Effect of early induction of hypothermia on severe head injury. Acta Neurochir, 2002, 81(Suppl): 83–84.
  19. 19. Bennett MH, Trytko B, Jonker B. Hyperbaric oxygen therapy for the adjunctive treatment of traumatic brain injury. The Cochrane Database of Systematic Reviews,2006, Issue 2.
  20. 20. Roberts I, Schierhout G. Hyperventilation therapy for acute traumatic brain injury. The Cochrane Database of Systematic Reviews,2006, Issue 2.
  21. 21. Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. The Cochrane Database of Systematic Reviews, 2006, Issue 2.