Marshall L F, Camp P E, Bowers S A
Neurosurgery. 1984 Jun;14(6):659-63. doi: 10.1227/00006123-198406000-00002.
Dimethyl sulfoxide (DMSO) has shown promise as a drug for the treatment of intracranial hypertension. In this report, we describe our experience in six patients, two who received a bolus administration of 10% DMSO and four who received a 20% solution titrated against the intracranial pressure (ICP). Five of the patients in this series suffered from severe head injury, and one had a cortical venous thrombosis associated with pregnancy. The first two patients were treated with a rapid infusion of a 10% solution of DMSO. Initially, the ICP was satisfactorily controlled using this method. Over time, however, fluid overload, severe electrolyte disturbances, and an ultimate loss of ICP control occurred. In subsequent patients, a 20% solution titrated against the ICP was used. Although ICP control was better achieved using this method of administration, problems with fluid management and electrolytes occurred again despite a high level of vigilance. In addition, because of the solvent properties of DMSO and its propensity over time to dissolve most standard intravenous infusion systems, mechanical difficulties in its administration were encountered in all six patients. The mechanism of action of DMSO is not well understood. It differs from the barbiturates, but acts too rapidly to function solely as a diuretic. The drug is extremely complex to use, and difficulties with its administration may make its risks ultimately greater than its potential benefits. Until more laboratory data are available concerning its use and better delivery systems are developed, neurosurgeons are cautioned against treating intracranial hypertension with DMSO.
二甲基亚砜（DMSO）已显示出有望成为治疗颅内高压的药物。在本报告中，我们描述了我们对6例患者的治疗经验，其中2例接受了10% DMSO的大剂量给药，4例接受了根据颅内压（ICP）滴定的20%溶液。该系列中的5例患者患有严重头部损伤，1例患有与妊娠相关的皮质静脉血栓形成。前2例患者接受了10% DMSO溶液的快速输注。最初，使用这种方法ICP得到了满意的控制。然而，随着时间的推移，出现了液体过载、严重的电解质紊乱，最终失去了对ICP的控制。在随后的患者中，使用了根据ICP滴定的20%溶液。尽管使用这种给药方法能更好地控制ICP，但尽管高度警惕，液体管理和电解质问题再次出现。此外，由于DMSO的溶剂特性及其随着时间推移溶解大多数标准静脉输液系统的倾向，所有6例患者在给药时都遇到了机械困难。DMSO的作用机制尚不清楚。它与巴比妥类药物不同，但起效太快，不可能仅仅作为利尿剂起作用。该药物使用极其复杂，给药困难可能最终使其风险大于潜在益处。在获得更多关于其使用的实验室数据并开发出更好的给药系统之前，神经外科医生应谨慎使用DMSO治疗颅内高压。
