Lewandowski-Belfer Julie J, Patel Alden V, Darracott Robert M, Jackson Daniel A, Nordeen Jerah D, Freeman W David
Department of Pharmacy, Spectrum Health - Butterworth, 100 Michigan NE, Grand Rapids, MI, 49503, USA,
Neurocrit Care. 2014 Jun;20(3):436-42. doi: 10.1007/s12028-013-9907-1.
The efficacy of administering single bolus doses of 14.6 or 23.4 % hypertonic saline (HTS) to treat refractory intracranial hypertension has been demonstrated in the literature and has emerged as an important therapeutic option in treating these patients. However, many institutions lack experience with this therapy and there are few published studies evaluating the safety of repeated bolus dosing of HTS.
A retrospective review of patients admitted between January 2008 and July 2012 was conducted to evaluate the use of repeated dosing of HTS in patients with refractory intracranial hypertension. The primary objective was to evaluate the safety of repeated dosing of HTS assessed by documented adverse effects such as central pontine myelinolysis (CPM) and severe fluctuations in serum sodium concentrations. Secondary objectives were to evaluate the efficacy of repeated dosing HTS in reducing intracranial pressure (ICP) and to compare the dose-response relationship of 14.6 and 23.4 % doses.
Fifty-five patients were included for evaluation, each receiving an average of 8.9 (range 2-61) doses of HTS. A statistically significant increase in mean serum sodium concentration occurred with the administration of HTS (p < 0.0001). No cases of CPM were identified. The use of HTS was found to be effective based on decreases in ICP after administration (p < 0.0001, mean ICP reduction: 10.1 mmHg, range 3-23.6 mmHg). The efficacy of 23.4 % saline in decreasing ICP was not found to be significantly different than 14.6 % saline (p = 0.23).
Repeat bolus dosing of 14.6 or 23.4 % HTS appears to be relatively safe and effective for treating refractory intracranial hypertension assuming there is frequent electrolyte monitoring and concomitant fluid management.
文献已证实单次推注14.6%或23.4%的高渗盐水（HTS）治疗难治性颅内高压的疗效，且已成为治疗这些患者的重要治疗选择。然而，许多机构缺乏这种治疗经验，且很少有已发表的研究评估HTS重复推注给药的安全性。
对2008年1月至2012年7月期间收治的患者进行回顾性研究，以评估HTS重复给药在难治性颅内高压患者中的应用。主要目的是通过记录如中枢桥脑髓鞘溶解症（CPM）和血清钠浓度严重波动等不良反应来评估HTS重复给药的安全性。次要目的是评估HTS重复给药降低颅内压（ICP）的疗效，并比较14.6%和23.4%剂量的剂量反应关系。
纳入55例患者进行评估，每位患者平均接受8.9次（范围为2 - 61次）HTS给药。HTS给药后平均血清钠浓度有统计学意义的升高（p < 0.0001）。未发现CPM病例。基于给药后ICP的降低，发现HTS的使用是有效的（p < 0.0001，平均ICP降低：10.1 mmHg，范围为3 - 23.6 mmHg）。未发现23.4%盐水降低ICP的疗效与14.6%盐水有显著差异（p = 0.23）。
假设进行频繁的电解质监测和伴随的液体管理，14.6%或23.4%的HTS重复推注给药治疗难治性颅内高压似乎相对安全有效。
