da Silva Joacil Carlos, de Lima Frederico de Melo Tavares, Valença Marcelo Moraes, de Azevedo Filho Hildo Rocha Cirne
Department of Neurosurgery, Hospital da Restauração, Agamenon Magalhães, SN, Recife, Pernambuco 51021-110, Brazil.
Neurol Res. 2010 Mar;32(2):139-43. doi: 10.1179/174313209X405119. Epub 2009 Mar 23.
Medical management of brain edema and elevated intracranial pressure (ICP) is a crucial challenge in neurosurgical practice. Depending on the cause, the treatments for brain edema fall into three categories: stabilization of the blood-brain barrier, depletion of brain water and surgical decompression. Although mannitol is the mainstay of hyperosmolar therapy, hypertonic saline (HS) is emerging as an effective alternative to traditional osmotic agents.
Experimental elevated ICP (50 mmHg) was induced in rabbits using an intracranial balloon. The effects of mannitol and HS (10% NaCl) were compared in this specific physiopathological model. Twelve animals were divided into three groups (control, HS and mannitol) according to intravenous administration of 0.9% NaCl, 10% NaCl or 20% mannitol 5 minutes after the elevation of ICP. The doses of 10% NaCl and 20% mannitol were iso-osmolar. During 90 minutes, continuous recording of ICP, mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) was realized.
The control group had a median survival of only 53 minutes, significantly lower than the treated groups (p=0.0002). There was statistical difference between mannitol and HS; the 10% NaCl group had lower values of ICP (p=0.0116) and higher values of MAP (p<0.0001) and CPP (p<0.0001).
The findings demonstrate higher efficacy of the 10% NaCl treatment in this comparison with 20% mannitol. Further efforts should be directed toward development of clinical studies using iso-osmotic doses of mannitol and HS in specific etiologies of intracranial hypertension.
脑水肿和颅内压（ICP）升高的药物治疗是神经外科实践中的一项关键挑战。根据病因，脑水肿的治疗可分为三类：血脑屏障稳定、脑水分清除和手术减压。尽管甘露醇是高渗疗法的主要药物，但高渗盐水（HS）正逐渐成为传统渗透剂的有效替代品。
使用颅内球囊在兔体内诱导实验性颅内压升高（50 mmHg）。在这个特定的生理病理模型中比较了甘露醇和高渗盐水（10%氯化钠）的效果。在颅内压升高5分钟后，根据静脉注射0.9%氯化钠、10%氯化钠或20%甘露醇将12只动物分为三组（对照组、高渗盐水组和甘露醇组）。10%氯化钠和20%甘露醇的剂量是等渗的。在90分钟内，持续记录颅内压、平均动脉压（MAP）和脑灌注压（CPP）。
对照组的中位生存期仅为53分钟，显著低于治疗组（p = 0.0002）。甘露醇和高渗盐水之间存在统计学差异；10%氯化钠组的颅内压值较低（p = 0.0116），平均动脉压（p < 0.0001）和脑灌注压（p < 0.0001）值较高。
研究结果表明，在本次比较中，10%氯化钠治疗比20%甘露醇具有更高的疗效。应进一步努力开展针对颅内高压特定病因，使用等渗剂量的甘露醇和高渗盐水的临床研究。
