高渗盐溶液治疗重型颅脑损伤的疗效与安全性

Efficacy and safety of hypertonic saline solutions in the treatment of severe head injury.

作者信息

Huang Sheng-Jean, Chang Lin, Han Yin-Yi, Lee Yuan-Chi, Tu Yong-Kwang

机构信息

Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan, ROC.

出版信息

Surg Neurol. 2006 Jun;65(6):539-46; discussion 546. doi: 10.1016/j.surneu.2005.11.019.

DOI:10.1016/j.surneu.2005.11.019

PMID:16720165

Abstract

BACKGROUND

The present study was undertaken to evaluate the efficacy and safety of hypertonic saline (HS) in the treatment of intracranial hypertension after severe head injury.

METHODS

This prospective, observational study was performed in an 11-bed neurosurgery intensive care unit of a teaching hospital. From February 2002 to September 2004, 18 severely head-injured patients with elevated intracranial pressure (ICP) and Glasgow Coma Scale scores of 5 to 8 (mean, 5.9 +/- 1.2) were admitted to the unit and treated according to a standard protocol. One dose per day of 3% saline was administered by rapid infusion (300 mL/20 min) when ICP values exceeded 20 mm Hg. After infusion, cerebral blood flow, ICP, blood pressure, end-tidal carbon dioxide, and heart rate were monitored continuously for 60 minutes and recorded. Serum osmolarity, sodium, potassium, chloride, arterial carbon dioxide pressure, arterial oxygen pressure, hemoglobin, lactic acid, and pH were measured immediately before infusion (zero time) and 20 and 60 minutes after infusion. Mean arterial pressure, cerebral perfusion pressure (CPP), mean flow velocity (MFV), and pulsatility index (PI) were also recorded and analyzed.

RESULTS

Intracranial pressure fell immediately after initiation of infusion with further significant decreases observed at 20 and 60 minutes (30.4 +/- 8.5, 24.3 +/- 7.4, and 23.8 +/- 8.3 mm Hg, respectively; P < .01). At these respective times CPP increased significantly (78.7 +/- 8.7, 83.2 +/- 7.8, and 87.2 +/- 12.8 mm Hg), PI dropped rapidly (1.51 +/- 0.42, 1.38 +/- 0.32, and 1.34 +/- 0.33) and MFV increased (66.26 +/- 25.91, 71.92 +/- 28.13, and 68.74 +/- 28.44). Serum sodium increased from 141.3 +/- 7.2 to 146.3 +/- 7.2 mmol/L after 20 minutes and returned to 144.3 +/- 7.36 mmol/L at 60 minutes. Potassium concentrations decreased significantly from 3.9 +/- 0.39 to 3.55 +/- 0.35 mmol/L after 20 minutes (P < .01). Lactic acid values at 0, 20, and 60 minutes were 1.6 +/- 0.5, 1.47 +/- 0.48, and 1.38 +/- 0.53 mmol/L, respectively (P < .01).

CONCLUSION

Rapid infusion of single dose daily of HS is a safe alternative for the treatment of elevated ICP in severe head injury. Further evaluations of long-term consequences and complications and of maximal tolerance to this treatment are required.

摘要

背景

本研究旨在评估高渗盐水（HS）治疗重度颅脑损伤后颅内高压的疗效和安全性。

方法

这项前瞻性观察性研究在一家教学医院的11张床位的神经外科重症监护病房进行。2002年2月至2004年9月，18例重度颅脑损伤且颅内压（ICP）升高、格拉斯哥昏迷量表评分为5至8分（平均5.9±1.2）的患者被收入该病房，并按照标准方案进行治疗。当ICP值超过20 mmHg时，每天通过快速输注（300 mL/20分钟）给予一剂3%盐水。输注后，连续60分钟监测脑血流量、ICP、血压、呼气末二氧化碳和心率并记录。在输注前（零时）以及输注后20分钟和60分钟立即测量血清渗透压、钠、钾、氯、动脉二氧化碳分压、动脉氧分压、血红蛋白、乳酸和pH值。还记录并分析平均动脉压、脑灌注压（CPP）、平均流速（MFV）和搏动指数（PI）。

结果

输注开始后ICP立即下降，在20分钟和60分钟时进一步显著下降（分别为30.4±8.5、24.3±7.4和23.8±8.3 mmHg；P<.01）。在这些相应时间，CPP显著升高（78.7±8.7、83.2±7.8和87.2±12.8 mmHg），PI迅速下降（1.51±0.42、1.38±0.32和1.34±0.33），MFV增加（66.26±25.91、71.92±28.13和68.74±28.44）。20分钟后血清钠从141.3±7.2 mmol/L升至146.3±7.2 mmol/L，60分钟时降至144.3±7.36 mmol/L。钾浓度在20分钟后从3.9±0.39 mmol/L显著降至3.55±0.35 mmol/L（P<.01）。0、20和60分钟时的乳酸值分别为1.6±0.5、1.47±0.48和1.38±0.53 mmol/L（P<.01）。