Division of Neurological Surgery, University of Alabama at Birmingham, Alabama, USA.
J Neurosurg. 2012 Jan;116(1):210-21. doi: 10.3171/2011.7.JNS102142. Epub 2011 Sep 23.
Currently, mannitol is the recommended first choice for a hyperosmolar agent for use in patients with elevated intracranial pressure (ICP). Some authors have argued that hypertonic saline (HTS) might be a more effective agent; however, there is no consensus as to appropriate indications for use, the best concentration, and the best method of delivery. To answer these questions better, the authors performed a review of the literature regarding the use of HTS for ICP reduction.
A PubMed search was performed to locate all papers pertaining to HTS use. This search was then narrowed to locate only those clinical studies relating to the use of HTS for ICP reduction.
A total of 36 articles were selected for review. Ten were prospective randomized controlled trials (RCTs), 1 was prospective and nonrandomized, 15 were prospective observational trials, and 10 were retrospective trials. The authors did not distinguish between retrospective observational studies and retrospective comparison trials. Prospective studies were considered observational if the effects of a treatment were evaluated over time but not compared with another treatment.
The available data are limited by low patient numbers, limited RCTs, and inconsistent methods between studies. However, a greater part of the data suggest that HTS given as either a bolus or continuous infusion can be more effective than mannitol in reducing episodes of elevated ICP. A meta-analysis of 8 prospective RCTs showed a higher rate of treatment failure or insufficiency with mannitol or normal saline versus HTS.
目前，甘露醇是治疗颅内压升高（ICP）患者的首选高渗剂。一些作者认为高渗盐水（HTS）可能是一种更有效的药物；然而，对于其适用的指征、最佳浓度和最佳给药方法尚未达成共识。为了更好地回答这些问题，作者对 HTS 降低 ICP 的应用文献进行了回顾。
通过 PubMed 检索所有与 HTS 使用相关的论文。然后将检索范围缩小到仅定位与 HTS 降低 ICP 相关的临床研究。
共选择了 36 篇文章进行综述。其中 10 篇为前瞻性随机对照试验（RCT），1 篇为前瞻性非随机对照试验，15 篇为前瞻性观察性试验，10 篇为回顾性试验。作者没有区分回顾性观察性研究和回顾性比较性试验。如果治疗效果是随时间评估的，但没有与另一种治疗方法进行比较，则前瞻性研究被认为是观察性的。
现有数据受到患者数量少、RCT 有限以及研究之间方法不一致的限制。然而，大部分数据表明，HTS 无论是作为推注还是连续输注，在降低 ICP 升高的发作方面都比甘露醇更有效。8 项前瞻性 RCT 的荟萃分析显示，与 HTS 相比，甘露醇或生理盐水的治疗失败或不足率更高。
