Forsyth Lisa L, Liu-DeRyke Xi, Parker Dennis, Rhoney Denise H
Department of Pharmaceutical Services, William Beaumont Hospital, Royal Oak, MI, USA.
Pharmacotherapy. 2008 Apr;28(4):469-84. doi: 10.1592/phco.28.4.469.
Increased intracranial pressure after neurologic injury is a clinical challenge that often requires administration of osmotic agents. The most common osmotic agent used for treatment has been mannitol; however, interest has been renewed in using hypertonic saline after neurologic injury, since it is not associated with hypovolemia. The types of procedures or injury for which hypertonic saline has been used are vast, from elective craniotomy for tumor resection to stroke and traumatic brain injury. Unfortunately, there is a paucity of well-controlled clinical trials that provide evidence for the best concentration, administration approach, and length of therapy with hypertonic saline. The bulk of the data exists for traumatic brain injury, although most of these data are from observational and retrospective analyses, which do not allow for an evaluation of the impact of hypertonic saline on clinical outcomes. Nonetheless, both animal and clinical data suggest that patients with traumatic brain injury and those with stroke may benefit from hypertonic saline therapy. Since hypertonic saline has a high risk of injury with inappropriate administration and is considered a "high-alert" drug, safety issues surrounding its dispensing and administration must be considered. Randomized outcome trials comparing mannitol with hypertonic saline in various subpopulations of neurologic injury would add valuable information to the literature and provide a basis for establishment of best clinical practices.
神经损伤后颅内压升高是一项临床挑战，通常需要使用渗透性药物。过去治疗中最常用的渗透性药物是甘露醇；然而，神经损伤后使用高渗盐水重新引起了人们的兴趣，因为它不会导致血容量减少。高渗盐水的应用范围广泛，涵盖了从肿瘤切除的择期开颅手术到中风和创伤性脑损伤等各种手术或损伤类型。不幸的是，缺乏严格对照的临床试验来为高渗盐水的最佳浓度、给药方法和治疗时长提供证据。尽管大部分数据来自观察性和回顾性分析，无法评估高渗盐水对临床结局的影响，但关于创伤性脑损伤的数据最多。尽管如此，动物和临床数据均表明，创伤性脑损伤患者和中风患者可能从高渗盐水治疗中获益。由于高渗盐水给药不当会造成高损伤风险，且被视为“高警示”药物，因此必须考虑其调配和给药过程中的安全问题。在神经损伤的不同亚组中比较甘露醇和高渗盐水的随机对照试验将为文献增添有价值的信息，并为确立最佳临床实践提供依据。
