Effect Of Different Intracranial Pressure Drug Combinations On Intracranial Hypertension Induced By Severe Brain Injury And Its Effect On Renal Electrolytes

Objective: It is used to select the commonly used intracranial pressure drugs for combination,to compare the effects of different intracranial pressure drugs to reduce the intracranial pressure,duration and adverse reactions,to provide the basis for clinical treatment of intracranial hypertension drug selection.Methods:(1)A prospective study was performed on 105 cases of severe brain injury admitted to the Department of Neurosurgery,Affiliated Hospital of Medical College from September 2016 to February 2018.(2)According to the admission time,they were randomly divided into 4 groups.Patients in which 20% mannitol 125 ml and furosemide 20 mg were alternately used were in group A;patients in which 20% mannitol 125 ml and torsemide 20 mg were alternately used were group B;The patients who used alternating 3% hypertonic saline100 ml and furosemide 20 mg were group C;patients who were alternately using 3%hypertonic saline 100 ml and torsemide 20 mg were group D.(3)Continuous monitoring of intracranial pressure(ICP)using an invasive intracranial pressure monitor.The ICP values before and after the medication were recorded for each group of patients.At the same time,the daily blood creatinine,urea nitrogen,sodium ion and potassium ion were monitored,and related parameters were summarized and statistically analyzed.Results:(1)The mean intracranial pressure after administration of the four groups of patients was reduced to the lowest one hour after administration.The intracranial pressure drop in the four groups and the time required for the intracranial pressure to rise back to 20 mmHg were significantly different(P<0.05).(2)There was no significant difference in theincidence of creatinine greater than normal in the four groups(P>0.05).The incidence of creatinine greater than normal was significantly different between the 20% mannitol combination group and the 3% hypertonic saline combination group(P<0.05).The mean value of creatinine increased after treatment in all groups.(3)There was no significant difference in the incidence of urea nitrogen greater than normal in the four groups(P>0.05).The abnormal incidence of urea nitrogen was significantly different between the 20%mannitol combination group and the 3% hypertonic saline combination group(P<0.05),and the average urea nitrogen level was increased after treatment in each group.(4)There was a statistically significant difference in the incidence of sodium ion abnormalities in the four groups after administration(P<0.05).The sodium ion levels in all groups were increased after administration.(5)There was no significant difference in the incidence of blood potassium ion in the four groups after treatment(P>0.05).There was a statistically significant difference in the incidence of abnormal potassium ion in the furosemide combination group and the torsemide combination group(P<0.05).Conclusion:(1)The effect of reducing intracranial pressure was obvious in all four drug combinations.However,3% hypertonic saline combined reduced the intracranial pressure amplitude more than the mannitol combination,and the duration of intracranial pressure reduction was longer than that of the mannitol combination.(2)The combination of 3%hypertonic saline and torasemide to reduce intracranial pressure and long duration of intracranial pressure can reduce the incidence of adverse reactions such as renal impairment,hypernatremia and hypokalemia.It should be an ideal combination for reducing intracranial pressure.