高渗溶液治疗颅内高压的研究进展

Hyperosmolar solutions for management of raised intracranial pressure： new concepts

背景 高渗溶液是治疗颅内高压（〉20 mmHg）（1 mmHg=0.133 kPa）的有效手段。甘露醇和高渗盐水为临床上常用的两种降颅压高渗溶液。目前临床上选择这两种液体治疗颅内高压存在争议。 目的 促进人们深入理解高渗溶液对颅内高压的影响。 内容 对这两种高渗溶液的作用特点、机制、临床应用及副作用等方面的研究进展作一综述。最近发表的荟萃分析未能明确哪种高渗液体在处理颅内高压和增加脑灌注压方面更佳，但在高渗治疗时维持血浆渗透压〈320 mOsm/L和血钠水平在145 mmol/L^155 mmol/L是合适的。 趋向 研究不同高渗液体的适应症、应用时机、最佳剂量，有助于颅内高压患者的临床处理。

Background The hyperosmolar solutions are an effective therapy for raised intracranial pressure（〉20 mmHg）（1 mmHg=0.133 kPa）. The two commonly used hyperosmolar solutions are mannitoli and hypertonic saline in clinical practice. However, there is controversy on how to select hyperosmolar solutions to manage raised intracranial pressure. Objective To promote people to deeply understand the effect of hyperosmolar solutions on the raised intracranial pressure. Content In this paper the pharmacologic mechanisms, clinical applications and adverse effects of the two hyperosmolar solutions in recent researches are reviewed. Recent published meta-analysis failed to confirm which hyperosmolar solution is better in management of intracranial hypertension and cerebral perfusion pressure,however, maintaining plasma osmolality 〈320 mOsm/L and sodium level between 145 mmol/L-155 mmol/L is appropriate during hyperosmolar therapy. Trend The studies on indications, timing and optimal dose of those hyperosmolar solutions will be helpful in clinical management of patients with intracranial hypertension.