Department of Neurosurgery, Cleveland Clinic, Cleveland, OH 44195, USA.
Neurocrit Care. 2012 Aug;17(1):117-30. doi: 10.1007/s12028-011-9649-x.
The use of hyperosmolar agents for intracranial hypertension was introduced in the early 20th century and remains a mainstay of therapy for patients with cerebral edema. Both animal and human studies have demonstrated the efficacy of two hyperosmolar agents, mannitol and hypertonic saline, in reducing intracranial pressure via volume redistribution, plasma expansion, rheologic modifications, and anti-inflammatory effects. However, because of physician and institutional variation in therapeutic practices, lack of standardized protocols for initiation and administration of therapy, patient heterogeneity, and a paucity of randomized controlled trials have yielded little class I evidence on which clinical decisions can be based, most current evidence regarding the use of hyperosmolar therapy is derived from retrospective analyses (class III) and case series (class IV). In this review, we summarize the available evidence regarding the use of hyperosmolar therapy with mannitol or hypertonic saline for the medical management of intracranial hypertension and present a comprehensive discussion of the evidence associated with various theoretical and practical concerns related to initiation, dosage, and monitoring of therapy.
高渗剂在 20 世纪初被引入治疗颅内高压，至今仍是脑水肿患者治疗的主要方法。动物和人体研究都表明，甘露醇和高渗盐水这两种高渗剂通过容积重分布、血浆扩容、流变学改变和抗炎作用降低颅内压是有效的。然而，由于医生和医疗机构在治疗实践方面存在差异，缺乏治疗启动和管理的标准化方案，患者异质性以及随机对照试验的缺乏，使得基于临床决策的循证医学证据很少（I 级），目前关于高渗治疗的大多数证据都来自回顾性分析（III 级）和病例系列（IV 级）。在这篇综述中，我们总结了关于使用甘露醇或高渗盐水进行颅内高压的医学治疗的高渗治疗的现有证据，并全面讨论了与治疗的启动、剂量和监测相关的各种理论和实际问题的证据。
