Qureshi A I, Suarez J I, Castro A, Bhardwaj A
Division of Neurosciences Critical Care, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
J Trauma. 1999 Oct;47(4):659-65. doi: 10.1097/00005373-199910000-00009.
Hypertonic saline (HS) recently has been introduced as a new form of hyperosmolar treatment in patients with brain injury from diverse causes. We reviewed our experience with the use of continuous hypertonic saline/acetate infusion in patients with cerebral edema attributable to head trauma.
We performed a retrospective chart review of all patients admitted with severe head injury, defined as admission Glasgow Coma Scale score of 8 or less, in the neurocritical care unit of a University hospital. Intravenous infusion of 2% or 3% saline/acetate for treatment of cerebral edema was introduced in the unit in April of 1993. The clinical characteristics, interventions required, and outcomes in patients who received HS were compared with patients who received 0.9% saline infusion only. Multivariate analyses were used to evaluate the impact of HS use on in-hospital mortality and Glasgow Outcome Scale score at discharge.
Thirty-six patients with cerebral edema caused by head trauma received infusion of HS initiated within 48 hours of admission for a mean period of 72 +/- 85 hours. Compared with 46 patients who did not receive HS, there were no differences observed in age and admission Glasgow Coma Scale scores. Patients who received HS were more likely to have a penetrating injury (p = 0.07) and a mass lesion on initial computed tomographic scan (p = 0.07). There was no difference between frequency of use of hyperventilation, mannitol, cerebrospinal fluid drainage, and vasopressors between the two groups. The requirement for pentobarbital coma was higher in HS group (n = 7 patients) versus control group (n = 2,p = 0.04). After adjusting for differences between both groups, infusion of HS was associated with higher in-hospital mortality (OR, 3.1; 95% CI, 1.1-10.2).
HS administration as prolonged infusion does not seem to favorably impact on requirement for other interventions and in-hospital mortality in our experience. Further efforts should be directed toward use of HS as bolus administrations or short infusions.
高渗盐水（HS）最近已被引入作为一种针对各种原因导致脑损伤患者的新型高渗治疗方法。我们回顾了在因头部创伤导致脑水肿的患者中使用持续高渗盐水/醋酸盐输注的经验。
我们对一家大学医院神经重症监护病房收治的所有重度颅脑损伤患者进行了回顾性病历审查，重度颅脑损伤定义为入院时格拉斯哥昏迷量表评分为8分或更低。1993年4月该病房开始静脉输注2%或3%盐水/醋酸盐治疗脑水肿。将接受高渗盐水治疗的患者的临床特征、所需干预措施和结局与仅接受0.9%盐水输注的患者进行比较。采用多变量分析评估使用高渗盐水对住院死亡率和出院时格拉斯哥预后量表评分所产生的影响。
36例因头部创伤导致脑水肿的患者在入院后48小时内开始接受高渗盐水输注，平均输注时间为72±85小时。与46例未接受高渗盐水治疗的患者相比，在年龄和入院时格拉斯哥昏迷量表评分方面未观察到差异。接受高渗盐水治疗的患者更有可能存在穿透性损伤（p = 0.07），且在初次计算机断层扫描时有占位性病变（p = 0.07）。两组在过度换气、甘露醇、脑脊液引流和血管升压药的使用频率方面没有差异。高渗盐水组（n = 7例患者）对戊巴比妥昏迷的需求高于对照组（n = 2例，p = 0.04）。在对两组之间的差异进行调整后，高渗盐水输注与更高的住院死亡率相关（比值比，3.1；95%置信区间，1.1 - 10.2）。
根据我们的经验，长时间输注高渗盐水似乎对其他干预措施的需求和住院死亡率没有有利影响。应进一步致力于将高渗盐水作为推注给药或短时间输注使用。
