Effect Of Osmotic Drugs On Intracranial Hypertension In Children Under Intracranial Pressure Monitoring

Objective: To evaluate the clinical effects of 20% mannitol(MT),3% hypertonic saline(HTS)and glycerol fructose on intracranial hypertension in children with severe brain injury(s TBI)and traumatic intracranial hypertension(ICH).Methods:Thirty children with severe traumatic brain injury were randomly divided into two groups: Group A(N = 20),were treated with 20%MT,Group B(N =10),were treated with 3%HTS.Group A was randomly divided into A1 and A2 groups after 24 hours’ treatment,10 patients in Group A1 were treated with 20% MT and 10 patients in group A2 were treated with glycerol fructose.The dosage of 20% MT and glycerolfructose was 5ml/kg.The dosage of 3%HTS was 3ml/kg,intravenous infusion timewere 30 minutes.The intracranial pressure(ICP)、cerebral perfusion pressure(CPP)、central venous pressure(CVP)、mean arterial pressure(MAP)were measured before and30 min,1h,2 h and 4 h after administration.To evaluate the efficacy of three osmotic drugs in treating intracranial pressure and the effect of three drugs on cerebral perfusion pressure as well as circulation.Results:1.The general data of the children in the study group: sex,age,injury factors,coma(Glasgow,GCS)score,ICP、CPP、MAP、CVP before medication,there was no significant difference(p>0.05),which can be compared.2.The changes of ICP,CPP,MAP and CVP in A and B groups at different time before and after administration: The changes of ICP,CPP,MAP and CVP in A and B groups at different time before and after administration,the differences were statistically significant(p<0.05).(1)The ICP in both groups decreased more than before,and decreased to the lowest at 2 hours after administration,and then showed a rising trend.In group A,the falling range was larger and the rising speed was slightly faster,and the ICP did not rise to the pre-administration level in both groups 4 hours after administration.(2)The CPP in both groups increased more than before and reached the highest2 hours after administration,and then began to decrease.In group A,the level of CPP decreased significantly.In group B,CPP decreased 2 hours after administration,however,4 hours after treatment,the level was still higher than before treatment.(3)The MAP in group A was higher than before,and decreased 2 hours after administion,to 4 hours after treatment.MAP in group B was higher than before and sustained 4 hours after treatment.(4)CVP in both groups was lower than that before treatment,and decreased to the lowest one hour after treatment,and then began to recover slowly.3.The changes of ICP,CPP,MAP and CVP in group A1 and group A2 at different time after medication: the changes of ICP,CPP,MAP and CVP in group A1 and group A2 at different time after medication were statistically significant(p<0.05).(1)ICP decreased in both groups after administration,and began to rise again 2hours after administration.The rate of decline in group A1 was slightly faster than that in group A2.(2)CPP in Group A 1 increased to its peak at 1 hour after medication,decreased to near pre-medication level at 2 hours after medication,and decreased to lower level at4 hours after medication,but it's consistently above pre-medication levels.(3)Map in Group A 1 reached its peak 30 minutes after treatment,and then began to decrease.Map in Group A 1 decreased to its pre-treatment level 1 hour after treatment,and then continued to decrease.Map in group a 2 increased slowly after treatment,reached the peak gradually within 2 hours,then decreased,but never lower than the pre-medication level.(4)CVP decreased slowly in both groups,and reached the lowest level 1 hour after treatment,and then began to rise again.4.In this study,the minimum age was 2 months and the monitoring time was 1week.No intracranial infection or hemorrhage occurred during hospitalization.Conclusion:1.Acute intracranial hypertension can be reduced by 20% mannitol in the first place.During the course of treatment,attention should be paid to avoid the secondary brain injury caused by circulation fluctuation and low blood volume,3% hypertonic saline should be the first choice to reduce intracranial pressure.2.After improvement of acute intracranial hypertension,alternating 20%mannitol with glycerol fructose may maintain better cerebral perfusion pressure than using 20% mannitol alone to avoid ion disturbance and renal dysfunction.3.Intracranial pressure monitoring technology in children with intracranial hypertension is safe and effective,has an important guiding significance for clinical treatment,rational use can reduce complications,in the field of pediatrics worthy of promotion.