Horn P, Münch E, Vajkoczy P, Herrmann P, Quintel M, Schilling L, Schmiedek P, Schürer L
Department of Neurosurgery, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Germany.
Neurol Res. 1999 Dec;21(8):758-64. doi: 10.1080/01616412.1999.11741010.
Critically elevated intracranial pressure (ICP) represents the most important cause of morbidity and mortality in patients suffering from severe traumatic brain injury (TBI) and is a serious complication after subarachnoid hemorrhage (SAH). Thus new strategies for the control of ICP are required. Based on the evidence available hypertonic saline solution (HSS) may be a promising approach. It was therefore the aim of the present study to evaluate in a prospective manner the effects of HSS on ICP and cerebral perfusion pressure (CPP) in patients with therapy-resistant elevation of ICP. A total of 48 bolus infusions of HSS (7.5%, 2 ml kg-1 b.w.; infusion rate 20 ml min-1) were given intravenously (range 1-15 per patient) to 10 patients (age 41 +/- 6 years) with TBI and SAH. Only patients with ICP > 25 mmHg not responding to standard ICP-management protocol and plasma sodium (Na+) concentration < 150 mmol l-1 were included in the study. Within the first hour after HSS application, ICP decreased from 33 +/- 9 mmHg to 19 +/- 6 mmHg (p < 0.05) and further to 18 +/- 5 mmHg at the time of maximum effect (98 +/- 11 min post bolus). Decrease of ICP was accompanied by a rise of CPP from 68 +/- 11 mmHg to 79 +/- 11 mmHg (p < 0.05) after 1 h and further to 81 +/- 11 mmHg at the time of maximum effect. Plasma Na+ concentration was 141 +/- 6 mmol l-1 before and 143 +/- 5 mmol l-1 1 h after HSS bolus. Corresponding values for plasma osmolality were 302 +/- 11 and 308 +/- 12 mOsm l-1. When the ICP lowering effect was transient, subsequent HSS bolus was necessary 163 +/- 54 min after previous dosing. The present results indicate that repeated bolus application of HSS (7.5% NaCl, 2 ml kg-1 b.w.) is an effective measure to decrease ICP which is otherwise refractory to standard therapeutic approaches. Whether or not the therapy scheme is also suited as primary measure for the control of ICP remains to be established.
颅内压（ICP）极度升高是重度创伤性脑损伤（TBI）患者发病和死亡的最重要原因，也是蛛网膜下腔出血（SAH）后的严重并发症。因此，需要新的控制ICP的策略。基于现有证据，高渗盐溶液（HSS）可能是一种有前景的方法。因此，本研究的目的是前瞻性评估HSS对ICP治疗抵抗性升高患者的ICP和脑灌注压（CPP）的影响。对10例（年龄41±6岁）TBI和SAH患者静脉给予总共48次HSS推注（7.5%，2 ml/kg体重；输注速率20 ml/min）（每位患者1-15次）。仅将ICP>25 mmHg且对标准ICP管理方案无反应且血浆钠（Na+）浓度<150 mmol/L的患者纳入研究。在应用HSS后的第一小时内，ICP从33±9 mmHg降至19±6 mmHg（p<0.05），在最大效应时（推注后98±11分钟）进一步降至18±5 mmHg。ICP降低伴随着CPP在1小时后从68±11 mmHg升至79±11 mmHg（p<0.05），在最大效应时进一步升至81±11 mmHg。HSS推注前血浆Na+浓度为141±6 mmol/L，推注后1小时为143±5 mmol/L。血浆渗透压的相应值为302±11和308±12 mOsm/L。当ICP降低效果短暂性时，在前一次给药后163±54分钟需要再次给予HSS推注。目前的结果表明，重复推注应用HSS（7.5% NaCl，2 ml/kg体重）是降低ICP的有效措施，否则对标准治疗方法无效。该治疗方案是否也适合作为控制ICP 的主要措施仍有待确定。
