Effects Of Osmotic Therapy On Intracranial Pressure And Short-term Prognosis Of Postoperative Hypertensive Basal Ganglia Hemorrhage

Objective To compare the effects of 3% hypertonic saline and 20% mannitol on intracranial pressure and the short-term prognosis of postoperative hypertensive basal ganglia hemorrhage.Methods 1.Retrospective analysis was conducted on the clinical data of patients with intracranial pressure monitoring after the first postoperative cerebral hemorrhage in hypertensive basal ganglia region admitted to the Surgical Intensive Care Unit(SICU)of Fujian Provincial Hospital from January 2012 to July 2018.Patients who received only 3% hypertonic saline or 20% mannitol osmotic medication were included.Intracranial pressure(ICP),mean arterial pressure(MAP),cerebral perfusion pressure(CPP),central venous pressure(CVP),blood sodium level and plasma osmotic pressure were the main outcome measures during the day of surgery to 6 days after surgery.The incidence of acute kidney injury(AKI),successful offline events and Glasgow outcome scale(GOS)were compared between the two groups during the observational period.2.Repeated measurement analysis of variance was used to compare the differences in daily ICP,MAP,CPP,serum sodium level and osmotic pressure between the two groups within 7 days.Regarding the comparison of the degree of ICP decline between the two groups,the ICP on the day of surgery was used as the covariate to carry out the correction covariance analysis,and the difference of slope of the two groups of linear equations was observed.Chi-square test was used to compare the composition ratio distribution of blood sodium and osmotic pressure values and the incidence of AKI between the two groups.Kaplan-Meier survival curve and log-rank test were used to compare the difference of the events of the weaning of ventilator between the two groups.Fisher's exact test was used to compare the difference between two groups of GOS at 30 days.3.Therefore,the effects of the two osmotic agents on ICP,CPP,hemodynamics,electrolytes,renal function and mechanical ventilation support were compared,so as to reflect the effects of the two drugs on intracranial pressure and short-term prognosis of patients with postoperative hypertensive basal ganglia cerebral hemorrhage.Results 1.There was no significant difference in the demographic characteristics between the 3% hypertonic saline group and the 20% mannitol group(p>0.05),which was comparable.2.There was no significant increase in ICP level in the two groups,and the ICP in the 3% hypertonic saline group was lower,but the difference in the degree of ICP reduction between the two groups was not significant statistically(p<0.05).3.The effects of 3% hypertonic saline and 20% mannitol on CPP and hemodynamics of patients with postoperative hypertensive basal ganglia cerebral hemorrhage were similar(p>0.05).4.The serum sodium level and osmotic pressure in the 3% hypertonic saline group were significantly higher than those in the 20% mannitol group(p<0.05),but there was no significant difference in renal damage between the two groups(p>0.05).5.In the case of successful weaning,there was no significant advantage in the 3% hypertonic saline group(p>0.05);6.There was no significant difference between the two groups in GOS after 30 days(p>0.05).Conclusions Both 3% hypertonic saline and 20% mannitol can play a good role in maintaining ICP of postoperative patients with hypertensive basal ganglia cerebral hemorrhage.Although the ICP controlled by 3% hypertonic saline is lower,there is no significant difference between the two in reducing ICP.The effects of the two osmotic agents on cerebral perfusion and hemodynamics were similar.The serum sodium and osmotic pressure were higher in the 3% hypertonic saline group,but the incidence of renal damage was similar in both groups.The lower ICP controlled by 3% hypertonic saline did not benefit the short-term prognosis of patients with postoperative hypertensive basal ganglia cerebral hemorrhage.Large,multicenter,prospective control studies are needed to compare the effects of the two agents on the prognosis of patients with postoperative cerebral hemorrhage in the basal ganglia region of hypertension.