Strandvik G F
Anaesthesia and Intensive Care Medicine, South Eastern School of Anaesthesia, London, UK.
Anaesthesia. 2009 Sep;64(9):990-1003. doi: 10.1111/j.1365-2044.2009.05986.x.
Hypertonic saline has been in clinical use for many decades. Its osmotic and volume-expanding properties make it theoretically useful for a number of indications in critical care. This literature review evaluates the use of hypertonic saline in critical care. The putative mechanism of action is presented, followed by a narrative review of its clinical usefulness in critical care. The review was conducted using the Scottish Intercollegiate Guidelines Network method for the review of cohort studies, randomised-controlled trials and meta-analyses. The review focuses specifically on blood pressure restoration and outcome benefit in both haemorrhagic and non-haemorrhagic shock, and the management of raised intracranial pressure. Issues of clinical improvement and outcome benefit are addressed. Hypertonic saline solutions are effective for blood pressure restoration in haemorrhagic, but not other, types of shock. There is no survival benefit with the use of hypertonic saline solutions in shock. Hypertonic saline solutions are effective at reducing intracranial pressure in conditions causing acute intracranial hypertension. There is no survival or outcome benefit with the use of hypertonic saline solutions for raised intracranial pressure. Recommendations for clinical use and future directions of clinical research are presented.
高渗盐水已在临床使用数十年。其渗透和扩容特性使其在理论上可用于重症监护的多种适应症。本文献综述评估了高渗盐水在重症监护中的应用。介绍了其假定的作用机制，随后对其在重症监护中的临床实用性进行了叙述性综述。该综述采用苏格兰校际指南网络方法对队列研究、随机对照试验和荟萃分析进行综述。该综述特别关注在出血性和非出血性休克中恢复血压和改善预后，以及颅内压升高的管理。探讨了临床改善和预后获益的问题。高渗盐溶液对出血性休克的血压恢复有效，但对其他类型休克无效。在休克中使用高渗盐溶液没有生存获益。高渗盐溶液在导致急性颅内高压的情况下可有效降低颅内压。使用高渗盐溶液治疗颅内压升高没有生存或预后获益。提出了临床使用建议和临床研究的未来方向。
