Qureshi A I, Suarez J I, Bhardwaj A
Division of Neurosciences Critical Care, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
J Neurosurg Anesthesiol. 1998 Jul;10(3):188-92. doi: 10.1097/00008506-199807000-00010.
Hypertonic saline was recently introduced as a new hyperosmolar agent for treatment of intracranial hypertension and cerebral edema. It has the potential to cause a rebound phenomenon similar to other osmotic agents. The authors report on two patients with cerebral edema caused by hypertensive intracerebral hemorrhage who were treated with hypertonic saline infusion. Both patients improved clinically after 24 hours of hypertonic saline administration. However, both patients deteriorated clinically, 48 and 96 hours after initiation of therapy, despite continued hypertonic saline administration. Compared with pre-treatment computed tomographic scans, edema volume on repeat scans increased from 131 cc to 262 cc, and from 171 cc to 239 cc in the first and second patients, respectively, despite the lack of change in hematoma volume. Malignant edema formation late in the course of intracerebral hemorrhage after prolonged administration of hypertonic saline may represent a rebound phenomenon of hyperosmolar therapy. Further studies are warranted to identify the occurrence of this phenomenon and the subset of patients susceptible to it.
高渗盐水最近作为一种新的高渗性药物被用于治疗颅内高压和脑水肿。它有可能引发与其他渗透性药物类似的反跳现象。作者报告了两例因高血压性脑出血导致脑水肿并接受高渗盐水输注治疗的患者。在给予高渗盐水24小时后，两名患者的临床症状均有改善。然而，尽管持续给予高渗盐水治疗，但在治疗开始后的48小时和96小时，两名患者的临床症状均恶化。与治疗前的计算机断层扫描相比，尽管血肿体积没有变化，但再次扫描时，第一名患者和第二名患者的水肿体积分别从131立方厘米增加到262立方厘米，以及从171立方厘米增加到239立方厘米。在长时间给予高渗盐水后，脑出血病程后期出现恶性水肿形成可能代表高渗治疗的反跳现象。有必要进行进一步研究以确定这种现象的发生率以及易患该现象的患者亚组。
