Bhardwaj Anish, Ulatowski John A
Departments of Anesthesiology/Critical Care Medicine and Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
Curr Opin Crit Care. 2004 Apr;10(2):126-31. doi: 10.1097/00075198-200404000-00009.
Hypertonic saline solutions have received renewed attention as effective agents for the treatment of cerebral edema and in brain resuscitation in a variety of brain injury paradigms. Although evidence of the beneficial action of hypertonic saline solutions in traumatic brain injury is robust, data supporting use in other conditions are only now mounting.
Osmotic properties of hypertonic saline solutions have been well studied in laboratory-based studies in animal models and in patients with acute brain injury. There are, in addition, emerging data on the extraosmotic actions on brain pathophysiology. This review cites baseline literature and provides new evidence of actions of hypertonic saline solutions: (a). in augmenting cerebral blood flow after subarachnoid hemorrhage, (b). as an antiinflammatory adjunct, and (c). utility in chemonucleolysis for intervertebral disc disease and treatment of seizures associated with severe hyponatremia.
Brain injury from diverse etiologies including trauma, ischemic stroke, global cerebral ischemia from cardiac arrest, intraparenchymal or subarachnoid hemorrhage, infection, or toxic-metabolic derangements are commonly encountered in the clinical setting. Many of these conditions are associated with cerebral edema with or without elevated intracranial pressure. Osmotherapy constitutes the cornerstone of medical therapy for such patients. Hypertonic saline solutions have received renewed attention in clinical practice as osmotic agents for cerebral resuscitation. This article reviews experimental and clinical evidence of the efficacy of hypertonic saline solutions and elaborates on their use in patients with acute neurologic injury. Important areas for current and future research are highlighted before the use of hypertonic saline solutions can be accepted for widespread use.
高渗盐溶液作为治疗脑水肿和多种脑损伤模型脑复苏的有效药物，再次受到关注。尽管高渗盐溶液在创伤性脑损伤中有益作用的证据确凿，但支持其在其他情况下使用的数据目前才开始增多。
高渗盐溶液的渗透特性已在动物模型的实验室研究和急性脑损伤患者中得到充分研究。此外，关于其对脑病理生理学的渗透外作用也有新的数据出现。本综述引用了基础文献，并提供了高渗盐溶液作用的新证据：（a）. 在蛛网膜下腔出血后增加脑血流量；（b）. 作为抗炎辅助药物；（c）. 在化学溶核治疗椎间盘疾病及治疗与严重低钠血症相关的癫痫发作中的效用。
包括创伤、缺血性中风、心脏骤停导致的全脑缺血、脑实质内或蛛网膜下腔出血、感染或毒性代谢紊乱等多种病因引起的脑损伤在临床中很常见。这些情况中的许多都伴有或不伴有颅内压升高的脑水肿。渗透疗法是此类患者药物治疗的基石。高渗盐溶液作为脑复苏的渗透剂在临床实践中再次受到关注。本文综述了高渗盐溶液疗效的实验和临床证据，并阐述了其在急性神经损伤患者中的应用。在高渗盐溶液被广泛接受使用之前，强调了当前和未来研究的重要领域。
