Lumba-Brown Angela, Harley Jim, Lucio Simon, Vaida Florin, Hilfiker Mary
From the *Pediatric Emergency Medicine, Washington University School of Medicine, St Louis, MO; †PEMNetwork.org; ‡Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of California, San Diego, CA; §Division of Biostatistics and Bioinformatics, Department of Family and Preventive Medicine University of California, San Diego, CA; ∥Statistics Unit, HIV Neurobehavioral Research Program; and #Rady Children's Hospital, University of California, San Diego, CA.
Pediatr Emerg Care. 2014 Mar;30(3):139-45. doi: 10.1097/PEC.0000000000000084.
Three-percent hypertonic saline (HTS) is a hyperosmotic therapy used in pediatric traumatic brain injury to treat increased intracranial pressure and cerebral edema. It also promotes plasma volume expansion and cerebral perfusion pressure, immunomodulation, and anti-inflammatory response. We hypothesized that HTS will improve concussive symptoms of mild traumatic brain injury.
The study was a prospective, double-blind, randomized controlled trial. Children, 4 to 7 years of age with a Glasgow Coma Scale score greater than 13, were enrolled from a pediatric emergency department following closed-head injury upon meeting Acute Concussion Evaluation criteria with head pain. Patients were randomized to receive 10 mL/kg of HTS or normal saline (NS) over 1 hour. Self-reported pain values were obtained using the Wong-Baker FACES Pain Rating Scale initially, immediately following fluids, and at 2 to 3 days of discharge. The primary outcome measure was change in self-reported pain following fluid administration. Secondary outcome measures were a change in pain and postconcussive symptoms within 2 to 3 days of fluid administration. We used an intention-to-treat analysis.
Forty-four patients, ranging from 7 to 16 years of age with comparable characteristics, were enrolled in the study; 23 patients (52%) received HTS, and 21 (48%) received NS. There was a significant difference (P < 0.001) identified in the self-reported improvement of pain following fluid administration between the HTS group (mean improvement = 3.5) and the NS group (mean improvement = 1.1). There was a significant difference (P = 0.01) identified in the self-reported improvement of pain at 2 to 3 days after treatment between the HTS group (mean improvement = 4.6) and the NS group (mean improvement = 3.0). We were unable to determine a difference in other postconcussive symptoms following discharge.
Three-percent HTS is more effective than NS in acutely reducing concussion pain in children.
3%高渗盐水（HTS）是一种用于小儿创伤性脑损伤治疗颅内压升高和脑水肿的高渗疗法。它还能促进血浆容量扩张和脑灌注压、免疫调节及抗炎反应。我们假设HTS能改善轻度创伤性脑损伤的震荡症状。
本研究为前瞻性、双盲、随机对照试验。年龄在4至7岁、格拉斯哥昏迷量表评分大于13分、因闭合性颅脑损伤在小儿急诊科就诊且符合急性脑震荡评估标准伴有头痛的儿童纳入研究。患者被随机分为两组，一组在1小时内接受10 mL/kg的HTS，另一组接受生理盐水（NS）。最初、输液后即刻以及出院后2至3天，使用面部表情疼痛评分量表获取患者自我报告的疼痛值。主要结局指标为输液后自我报告疼痛的变化。次要结局指标为输液后2至3天内疼痛和脑震荡后症状的变化。我们采用意向性分析。
44名年龄在7至16岁、特征相似的患者纳入研究；23名患者（52%）接受HTS，21名（48%）接受NS。HTS组（平均改善 = 3.5）和NS组（平均改善 = 1.1）在输液后自我报告的疼痛改善方面存在显著差异（P < 0.001）。HTS组（平均改善 = 4.6）和NS组（平均改善 = 3.0）在治疗后2至3天自我报告的疼痛改善方面存在显著差异（P = 0.01）。我们无法确定出院后其他脑震荡后症状的差异。
3%的HTS在急性减轻儿童脑震荡疼痛方面比NS更有效。
