Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, 1295 North Martin, P.O. Box 210202, Tucson, AZ 85721-0207, USA.
Am J Health Syst Pharm. 2010 Nov 15;67(22):1920-8. doi: 10.2146/ajhp090523.
The use of hypertonic saline injection in trauma patients is discussed.
Patients with hemorrhage, burns, and traumatic brain injury (TBI) may develop hypovolemic shock and require resuscitation. Compared with conventional isotonic crystalloids, hypertonic saline has several advantages, including hemodynamic, immune-modulating, and antiinflammatory effects, for use in trauma patients for resuscitation. In addition, hypertonic saline is also used in patients with TBI to reduce intracranial pressure (ICP). Overall, studies have not shown a difference in mortality or other clinically important outcomes with the use of hypertonic saline for resuscitation in trauma patients; however, most of these studies were not adequately powered to show significant differences. A recent Cochrane review concluded that there is no evidence that hypertonic crystalloids are better than isotonic or near-isotonic crystalloids for fluid resuscitation in trauma patients. Two recent trials that were adequately powered to investigate a mortality endpoint were halted for futility. A few small randomized controlled studies found that hypertonic saline was more effective than mannitol as a hyperosmolar agent for ICP reduction. Recent guidelines from the American Burn Association have suggested that hypertonic saline may be used for burn shock resuscitation by experienced providers with close monitoring to avoid excessive hypernatremia. One of the main concerns with the use of hypertonic saline is its potential to cause central pontine myelinolysis due to a rapid increase in serum sodium levels.
There is no evidence that hypertonic saline provides any additional benefit over isotonic crystalloid solutions for trauma resuscitation. Hypertonic saline may be more effective than mannitol at reducing ICP in patients with TBI.
讨论在创伤患者中使用高渗盐水注射。
出血、烧伤和创伤性脑损伤（TBI）患者可能会出现低血容量性休克，需要复苏。与常规等渗晶体液相比，高渗盐水具有血流动力学、免疫调节和抗炎作用等优点，可用于创伤患者的复苏。此外，高渗盐水还用于 TBI 患者以降低颅内压（ICP）。总体而言，研究并未表明在创伤患者的复苏中使用高渗盐水在死亡率或其他临床重要结局方面存在差异；然而，这些研究大多数没有足够的效力来显示显著差异。最近的 Cochrane 综述得出的结论是，没有证据表明高渗晶体液在创伤患者的液体复苏中优于等渗或近似等渗晶体液。两项最近的、有足够效力来调查死亡率终点的试验因无效而停止。少数小型随机对照研究发现，高渗盐水作为 ICP 降低的高渗剂比甘露醇更有效。美国烧伤协会的最新指南建议，在有经验的提供者密切监测下，高渗盐水可用于烧伤休克复苏，以避免过度高钠血症。使用高渗盐水的主要关注点之一是其可能导致血清钠水平快速升高引起的桥脑中央髓鞘溶解症。
没有证据表明高渗盐水在创伤复苏方面比等渗晶体液提供任何额外益处。高渗盐水在降低 TBI 患者 ICP 方面可能比甘露醇更有效。
