Yildizdas D, Altunbasak S, Celik U, Herguner O
Pediatric Intensive Care Unit, Cukurova University Faculty of Medicine, Adana, Turkey.
Indian Pediatr. 2006 Sep;43(9):771-9.
To compare the efficacy and side effects of hypertronic saline and mannitol use in cerebral edema.
Retrospective study.
Pediatric intensive care unit.
67 patients with cerebral edema.
Patients with cerebral edema treated with either mannitol or hypertronic saline (HS) (Group II: n = 25), and both mannitol and HS (Group III: n = 20) were evaluated retrospectively. Cerebral edema and increased intracranial pressure were based on the clinical and/or radiological (CT, MR) findings. When treating with both mannitol and HS (Group IIIA), if patients serum osmality was greater than 325 mosmol/L, mannitol was stopped and patients were treated with only HS (Group IIIB). All patients were closely monitored for fever, pulse, blood pressure, central venous pressure (CVP), oxygen saturation, volume of fluid intake and urine output. Mannitol was given at a dose of 0.25-0.5 g/kg while the hypertonic saline was given as 3% saline to maintain the serum-Na within the range of 155-165 mEq/L.
There was no statistically significant difference in terms of Glasgow coma scale, age, gender, and etiologic distribution between the groups. And also distribution of the other treatments given for cerebral edema is not significiant. Mannitol was given for a total dose of 9.3 +/-5.0 (2-16) doses in Group I, and 6.5 +/-2.8 (2-10) doses in Group III. Hypertonic saline was infused for 4-25 times in Group II. Although there was no statistically significant difference in the highest serum Na and osmolarity levels of the groups, duration of comatose state and mortality rate were significantly lower in Group II and Group III A B. Patients who received only HS were subdivided according to their serum Na concentrations into 2 groups as those between 150-160 mEqL and those between 160-170 mEqL. The duration of comatose state and mortality was not different in patients with serum-Na of 150-160 mEqL and in patients with 160-170 mEqL in the hypertonic saline receiving patients. Four patients in the group II developed hyperchloremic metabolic acidosis and 2 patients in the group I had hypotension. As two patients in group II had diabetes insipidus and one patient had renal failure in group I, the treatment was terminated. The causes of death were septic shock, ventilator associated pneumonia with acute respiratory distress syndrome, progressive cerebral edema and cerebral edema with pulmonary edema. Multivariate analysis showed that age, gender, cause of cerebral edema, electrolyte imbalance, hyperglycemia and hyper-ventilation had no significant impact on outcome.
Hypertonic saline seems to be more effective than mannitol in the cerebral edema.
比较高渗盐水与甘露醇治疗脑水肿的疗效及副作用。
回顾性研究。
儿科重症监护病房。
67例脑水肿患者。
对接受甘露醇或高渗盐水（HS）治疗的脑水肿患者（第二组：n = 25）以及同时接受甘露醇和HS治疗的患者（第三组：n = 20）进行回顾性评估。脑水肿和颅内压升高基于临床和/或放射学（CT、MR）检查结果。在同时使用甘露醇和HS治疗时（第三A组），如果患者血清渗透压大于325 mosmol/L，则停用甘露醇，仅用HS治疗患者（第三B组）。密切监测所有患者的发热、脉搏、血压、中心静脉压（CVP）、血氧饱和度、液体摄入量和尿量。甘露醇的给药剂量为0.25 - 0.5 g/kg，而高渗盐水以3%盐水的形式给药，以维持血清钠在155 - 165 mEq/L范围内。
各组之间在格拉斯哥昏迷量表、年龄、性别和病因分布方面无统计学显著差异。用于治疗脑水肿的其他治疗方法的分布也无显著差异。第一组甘露醇的总给药剂量为9.3±5.0（2 - 16）剂，第三组为6.5±2.8（2 - 10）剂。第二组高渗盐水输注4 - 25次。虽然各组的最高血清钠和渗透压水平无统计学显著差异，但第二组和第三A、B组的昏迷状态持续时间和死亡率显著较低。仅接受HS治疗的患者根据其血清钠浓度分为两组，即150 - 160 mEq/L组和160 - 170 mEq/L组。接受高渗盐水治疗的患者中，血清钠为150 - 160 mEq/L的患者与血清钠为160 - 170 mEq/L的患者在昏迷状态持续时间和死亡率方面无差异。第二组中有4例患者发生高氯性代谢性酸中毒，第一组中有2例患者出现低血压。由于第二组中有2例患者发生尿崩症，第一组中有1例患者出现肾衰竭，因此终止治疗。死亡原因包括感染性休克、呼吸机相关性肺炎伴急性呼吸窘迫综合征、进行性脑水肿以及脑水肿伴肺水肿。多因素分析表明，年龄、性别、脑水肿病因、电解质失衡、高血糖和过度通气对预后无显著影响。
在治疗脑水肿方面，高渗盐水似乎比甘露醇更有效。
