| objective: Intracranial infection is a common pediatric critical illness, and preventing and controling intracranial hypertension is one of the important measures of treatment for intracranial infection. Through comparing the efficacy in decreasing intracranial pressure and the incidence of adverse reactions between the therapy with glycerol and fructose combined with mannitol and the therapy with mannitol alone, this research is to discuss the efficacy of glycerol and fructose combined with mannitol in decreasing the intracranial pressure in children with intracranial infection.We hope to get one treatment with better efficacy on reducing intracranial pressure and fewer side effects.Methods: 76 children admitted to hospital in 2011-2014,with intracranial infection including purulent meningitis, viral meningitis, tuberculous meningitis, were prospective analysed. All cases were consistent with intracranial hypertension diagnostic criteria. All patients were checked normal in renal function and electrolytes before treatment,and 60 cases of them were measured cerebrospinal fluid pressure by lumbar puncture before treatment.76 children were randomly divided into two groups------the control group with mannitol(n=38) and the treatment group(n=38) with glycerol and fructose combined with mannitol.We reviewed the intracranial pressure,clinical symptoms, renal function, electrolytes and urine routine after 5 days’ treatment and compared the differences between the both groups on decreasing of cerebrospinal fluid pressure, improvement of clinical symptoms,and incidence of renal damage and electrolyte imbalance caused by medication.Results: 1. The mean of CSF pressure of children of 1-3 years in treatment group after 5 days’ treatment was 107.2±18.04 mmH2 O,while that in control group was 192.22±39.93 mmH2 O. The CFS pressure of treatment group was lower than that of control group. The two groups were compared statistically,and we found there was significant difference(P<0.05). The mean of CSF pressure of children of 4-15 years in treatment group after 5 days’ treatment was 192.22±39.93mmH2 O,while that in control group was 222.13±31.05mmH2 O. The CFS pressure of treatment group was lower than that of control group. The two groups were compared statistically,and we found there was significant difference(P<0.05). It’s suggested that therapy with glycerol and fructose combined with mannitol has a much more significant effect on reducing the intracranial pressure in children with intracranial infection, comparing with the therapy with mannitol,and it is suitable for children of 1-3 and 4-15 years old.2. After 5 days’ treatment with glycerol and fructose combined with mannitol,the efficiency of droping cerebrospinal fluid pressure of the treatment group was 96.88%,while the efficiency of the control group was 78.57% after 5 days’ treatment with mannitol. The former was higher than the latter. The two groups were compared statistically,and we found there was significant difference in the CSF pressure drop(P<0.05). In terms of reducing the intracranial pressure,the treatment with glycerol and fructose combined with mannitol is better than traditional treatment with mannitol.3. Clinical symptom improvement rate of the treatment group was 94.37% after 5 days’ treatment with glycerol and fructose combined with mannitol,while that of control group was 84.21% after 5 days’ treatment with mannitol. The former was higher than the latter. The two groups were compared statistically,and we found there was significant difference in the clinical symptom improvement(P<0.05). In terms of improving clinical symptoms,the treatment with glycerol and fructose combined with mannitol is better than traditional treatment with mannitol.4. The incidence rate of renal damage of treatment group was 2.63%,while that of control group was 18.42%. The former was much lower than the latter. The two groups were compared statistically,and we found there was statistically significant difference(P<0.05).The incidence rate of electrolyte disturbance of treatment group was 5.26%,while that of control group was 23.68%. The former was much lower than the latter. The two groups were compared statistically,and we found there was statistically significant difference(P<0.05). That is to say the risk of side effects caused by therapy with glycerine and fructose combined with mannitol is much lower than that caused by therapy with mannitol alone.5、Of the 76 cases, the incidence rate of electrolyte disturbance of 1-3 age group was 17.64%, and that of 4-15 age group was 11.9%. Comparing the two age groups,we found no statistically significant difference(P>0.05). The incidence rate of renal damage of 1-3 age group was 17.64%, and that of 4-15 age group was 4.67%. Comparing the two age groups,we found no statistically significant difference(P>0.05). There are no difference between the two age groups of children in the incidence of electrolyte imbalance and renal damage after 5 days treatment with mannitol.Conclusions: The efficacy of glycerine and fructose combined with mannitol on reducing CSF pressure and improving clinical symptoms of intracranial hypertension is better than that of traditional mannitol alone in children with intracranial infection,and it is suitable for children from 1 to 15 years old. We found no obvious side effects caused by glycerol and fructose in this research. By reducing the dosage and frequency of mannitol, there are lower risk of adverse reactions caused by the therapy with glycerol fructose combined with mannitol,such as renal damage and electrolyte disturbances,than that caused by therapy with mannitol alone.So glycerol and fructose combined with mannitol is recommended to be used to lower the intracranial pressure, enhance the efficacy and reduce adverse reaction of mannitol in children with intracranial infection. |
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