Shackford S R, Bourguignon P R, Wald S L, Rogers F B, Osler T M, Clark D E
Department of Surgery, College of Medicine, University of Vermont, Burlington, USA.
J Trauma. 1998 Jan;44(1):50-8. doi: 10.1097/00005373-199801000-00004.
Experimental and clinical work has suggested that hypertonic saline (HTS) would be better than lactated Ringer's solution (LRS) for the resuscitation of patients with head injuries. No clinical study has examined the effect of HTS infusion on intracranial pressure (ICP) and outcome in patients with head injuries. We hypothesized that HTS infusion would result in a lower ICP and fewer medical interventions to lower ICP compared with LRS.
METHODS/DESIGN: Prospective, randomized clinical trial at two teaching hospitals.
Thirty-four patients were enrolled and were similar in age and Injury Severity Score. HTS patients had a lower admission Glasgow Coma Scale score (HTS: 4.7+/-0.7; LRS: 6.7+/-0.7; p = 0.057), a higher initial ICP (HTS: 16+/-2; LRS: 11+/-2; p = 0.06), and a higher initial mean maximum ICP (HTS: 31+/-3; LRS: 18+/-2; p < 0.01). Treatment effectively lowered ICP in both groups, and there was no significant difference between the groups in ICP at any time after entry. HTS patients required significantly more interventions (HTS: 31+/-4; LRS: 11+/-3; p < 0.01). During the study, the change in maximum ICP was positive in the LRS group but negative in the HTS group (LRS: +2+/-3; HTS: -9+/-4; p < 0.05).
As a group, HTS patients had more severe head injuries. HTS and LRS used with other therapies effectively controlled the ICP. The widely held conviction that sodium administration will lead to a sustained increase in ICP is not supported by this work.
实验和临床研究表明，对于头部受伤患者的复苏，高渗盐水（HTS）可能优于乳酸林格氏液（LRS）。尚无临床研究考察HTS输注对头部受伤患者颅内压（ICP）及预后的影响。我们假设，与LRS相比，HTS输注可使ICP降低，且降低ICP所需的医疗干预更少。
方法/设计：在两家教学医院进行的前瞻性随机临床试验。
34例患者入组，年龄和损伤严重程度评分相似。HTS组患者入院时格拉斯哥昏迷量表评分较低（HTS组：4.7±0.7；LRS组：6.7±0.7；p = 0.057），初始ICP较高（HTS组：16±2；LRS组：11±2；p = 0.06），初始平均最大ICP也较高（HTS组：31±3；LRS组：18±2；p < 0.01）。两组治疗均有效降低了ICP，入组后任何时间两组间ICP均无显著差异。HTS组患者需要更多的干预措施（HTS组：31±4；LRS组：11±3；p < 0.01）。研究期间，LRS组最大ICP变化为正值，而HTS组为负值（LRS组：+2±3；HTS组：-9±4；p < 0.05）。
总体而言，HTS组患者头部损伤更严重。HTS和LRS与其他治疗方法联合使用可有效控制ICP。这项研究不支持普遍认为的给予钠会导致ICP持续升高的观点。
