Qureshi A I, Suarez J I, Bhardwaj A, Mirski M, Schnitzer M S, Hanley D F, Ulatowski J A
Division of Neurosciences Critical Care, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Crit Care Med. 1998 Mar;26(3):440-6. doi: 10.1097/00003246-199803000-00011.
To determine the effect of continuous hypertonic (3%) saline/acetate infusion on intracranial pressure (ICP) and lateral displacement of the brain in patients with cerebral edema.
Retrospective chart review.
Neurocritical care unit of a university hospital.
Twenty-seven consecutive patients with cerebral edema (30 episodes), including patients with head trauma (n = 8), postoperative edema (n = 5), nontraumatic intracranial hemorrhage (n = 8), and cerebral infarction (n = 6).
Intravenous infusion of 3% saline/acetate to increase serum sodium concentrations to 145 to 155 mmol/L.
A reduction in mean ICP within the first 12 hrs correlating with an increase in the serum sodium concentration was observed in patients with head trauma (r2 = .91, p = .03), and postoperative edema (r2 = .82, p = .06), but not in patients with nontraumatic intracranial hemorrhage or cerebral infarction. In patients with head trauma, the beneficial effect of hypertonic saline on ICP was short-lasting, and after 72 hrs of infusion, four patients required intravenous pentobarbital due to poor ICP control. Among the 21 patients who had a repeat computed tomographic scan within 72 hrs of initiating hypertonic saline, lateral displacement of the brain was reduced in patients with head trauma (2.8 +/- 1.4 to 1.1 +/- 0.9 [SEM]) and in patients with postoperative edema (3.1 +/- 1.6 to 1.1 +/- 0.7). This effect was not observed in patients with nontraumatic intracranial bleeding or cerebral infarction. The treatment was terminated in three patients due to the development of pulmonary edema, and was terminated in another three patients due to development of diabetes insipidus.
Hypertonic saline administration as a 3% infusion appears to be a promising therapy for cerebral edema in patients with head trauma or postoperative edema. Further studies are required to determine the optimal duration of benefit and the specific patient population that is most likely to benefit from this treatment.
确定持续输注高渗（3%）盐水/醋酸盐对脑水肿患者颅内压（ICP）及脑侧移位的影响。
回顾性病历审查。
一所大学医院的神经重症监护病房。
27例连续的脑水肿患者（共30次发作），包括头部创伤患者（n = 8）、术后水肿患者（n = 5）、非创伤性颅内出血患者（n = 8）和脑梗死患者（n = 6）。
静脉输注3%盐水/醋酸盐，使血清钠浓度升至145至155 mmol/L。
头部创伤患者（r2 = 0.91，p = 0.03）和术后水肿患者（r2 = 0.82，p = 0.06）在输注后12小时内平均ICP降低，且与血清钠浓度升高相关，但非创伤性颅内出血或脑梗死患者未出现此情况。头部创伤患者中，高渗盐水对ICP的有益作用持续时间较短，输注72小时后，4例患者因ICP控制不佳需静脉注射戊巴比妥。在开始高渗盐水治疗后72小时内进行重复计算机断层扫描的21例患者中，头部创伤患者（从2.8±1.4降至1.1±0.9 [标准误]）和术后水肿患者（从3.1±1.6降至1.1±0.7）的脑侧移位减少。非创伤性颅内出血或脑梗死患者未观察到这种效果。3例患者因发生肺水肿而终止治疗，另外3例患者因发生尿崩症而终止治疗。
以3%的浓度输注高渗盐水似乎是治疗头部创伤或术后水肿患者脑水肿的一种有前景的疗法。需要进一步研究以确定最佳受益持续时间以及最可能从此治疗中受益的特定患者群体。
