Upadhyay Piyush, Tripathi V N, Singh R P, Sachan D
Pediatric Intensive Care Unit, Department of Pediatrics, GSVM Medical College, Kanpur (U.P.), India.
J Pediatr Neurosci. 2010 Jan;5(1):18-21. doi: 10.4103/1817-1745.66673.
To compare the efficacy and side effects of 3% hypertonic saline and mannitol in the management of raised intracranial pressure in children.
Prospective randomized study.
Pediatric intensive care unit (PICU) in a tertiary care hospital.
200 patients with raised intracranial pressure.
Patients were randomized into two statistically comparable groups; Group A (n = 98) was treated with mannitol while Group B (n = 100) was treated with 3% hypertonic saline. Group C (n = 2) included those members of Group A in whom serum osmolality ≥320 mosmol/kg and were then treated with 3% hypertonic saline. Both Drugs were given at a loading dose of 5 ml/kg stat followed by 2 ml/kg in every 6 h(both have same osmolarity) for two days in their respective groups. Besides monitoring, blood pressure (NIBP), mean arterial pressure (pre and post 30 min of drug), serum sodium, chloride and osmolality were measured. Intracranial pressure was assessed indirectly by measuring mean arterial ressure "MAP". Student paired 't' test was applied.
Decrease in MAP was highly significant (P<0.001) at 0 h in males 0,6 h in females, and moderately significant at 12,36 h in females and significant(P<0.05) at 6,24,42 h in males of Group B. Decrease in coma hours was a highly significant finding (P<0.001) in Group B. In Group B, serum sodium and chloride increased significantly but remained within acceptable limits. There was no difference in osmolality and mortality (fisher Z).
Mannitol has several side effects, 3% hypertonic saline is a safe and effective alternative in managing cerebral edema.
比较3%高渗盐水和甘露醇治疗儿童颅内压升高的疗效及副作用。
前瞻性随机研究。
一家三级医院的儿科重症监护病房（PICU）。
200例颅内压升高的患者。
将患者随机分为两组，两组在统计学上具有可比性；A组（n = 98）接受甘露醇治疗，B组（n = 100）接受3%高渗盐水治疗。C组（n = 2）包括A组中血清渗透压≥320 mosmol/kg的患者，随后接受3%高渗盐水治疗。两组均先静脉推注5 ml/kg负荷剂量，然后每6小时静脉滴注2 ml/kg（两者渗透压相同），持续两天。除监测血压（无创血压）、平均动脉压（用药前及用药后30分钟）外，还测量血清钠、氯和渗透压。通过测量平均动脉压“MAP”间接评估颅内压。采用学生配对t检验。
B组男性在0小时、女性在0、6小时时MAP下降非常显著（P<0.001），女性在12、36小时时中度显著，男性在6、24、42小时时显著（P<0.05）。B组昏迷小时数减少是一个非常显著的结果（P<0.001）。在B组中，血清钠和氯显著升高，但仍在可接受范围内。渗透压和死亡率（Fisher Z）无差异。
甘露醇有多种副作用，3%高渗盐水是治疗脑水肿的一种安全有效的替代药物。
