Tarimah Khairunnisai, Bramawangsa Lalu B, Suhardi Christian J, Wiyarta Elvan, Bisri Dewi Y
Department of Anesthesiology and Intensive Therapy, Dr Hasan Sadikin Hospital - Padjadjaran University, Bandung, West Java, Indonesia.
Department of Anesthesiology and Intensive Therapy, RSUD Kota Mataram-Universitas Islam Al-Azhar, Lombok, Nusa Tenggara Barat, Indonesia.
J Taibah Univ Med Sci. 2024 Sep 19;19(5):961-973. doi: 10.1016/j.jtumed.2024.09.001. eCollection 2024 Oct.
Brain tumor craniotomy requires relaxation of the brain through decreasing the intracranial pressure (ICP). Osmo-hyperosmolar therapy can be used to lower the ICP.
This study was aimed at updating previous studies to determine the effects and safety of using hypertonic saline (HTS) and mannitol to decrease ICP in adult patients with brain tumors undergoing craniotomy.
To identify randomized controlled trials (RCTs) comparing HTS vs mannitol, we performed a systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, by examining records from 2013 to December of 2023 in five databases. The primary outcome was brain relaxation, and the secondary outcomes were cerebral perfusion pressure (CPP), urine output (UO), fluid input, mean arterial pressure (MAP), and plasma sodium. Conventional meta-analysis, Bayesian meta-insight analysis, trial-sequential analysis, and trial quality assessment were conducted.
Eleven RCTs involving 593 participants were included in the meta-analysis. Use of HTS, compared with mannitol, was associated with significantly greater brain relaxation, and significantly lower UO and fluid input. HTS was also significantly associated with elevated MAP. Plasma sodium was significantly higher in the HTS group than the mannitol group. No significant difference in CPP was observed between groups. Trial sequential analysis indicated true significance for the brain relaxation outcomes. Bayesian analysis demonstrated the superiority of 3% HTS at 5 ml/kg in achieving brain relaxation, followed by 3% HTS at 5.3 ml/kg and 20% mannitol at 5 ml/kg.
HTS is superior to mannitol in achieving optimal brain relaxation, maintaining stable blood flow, and minimizing diuretic effects. However, use of HTS during tumor craniotomy procedures can increase plasma sodium levels. The optimal dose for achieving brain relaxation appears to be 3% HTS at 5 ml/kg body weight.
脑肿瘤开颅手术需要通过降低颅内压（ICP）来使大脑松弛。渗透-高渗疗法可用于降低颅内压。
本研究旨在更新以往研究，以确定使用高渗盐水（HTS）和甘露醇降低接受开颅手术的成年脑肿瘤患者颅内压的效果和安全性。
为了识别比较HTS与甘露醇的随机对照试验（RCT），我们根据系统评价和Meta分析的首选报告项目指南，通过检索五个数据库中2013年至2023年12月的记录进行了系统文献检索。主要结局是脑松弛，次要结局是脑灌注压（CPP）、尿量（UO）、液体输入量、平均动脉压（MAP）和血浆钠。进行了传统Meta分析、贝叶斯Meta洞察分析、试验序贯分析和试验质量评估。
Meta分析纳入了11项涉及593名参与者的RCT。与甘露醇相比，使用HTS与显著更大程度的脑松弛、显著更低的UO和液体输入量相关。HTS还与MAP升高显著相关。HTS组的血浆钠显著高于甘露醇组。两组之间未观察到CPP有显著差异。试验序贯分析表明脑松弛结局具有真正的显著性。贝叶斯分析表明，5 ml/kg的3% HTS在实现脑松弛方面具有优势，其次是5.3 ml/kg的3% HTS和5 ml/kg的20%甘露醇。
在实现最佳脑松弛、维持稳定血流和最小化利尿作用方面，HTS优于甘露醇。然而，在肿瘤开颅手术过程中使用HTS会增加血浆钠水平。实现脑松弛的最佳剂量似乎是5 ml/kg体重的3% HTS。
