高渗盐水治疗脑水肿和颅内高压的研究进展

Research Progress of Hypertonic Saline in the Treatment of Cerebral Edema and Intracranial Hypertension

背景：脑水肿和颅内压（intracranIalpressure，IOP）增高是诸多神经外科疾病共有的病理学特点。有效治疗脑水肿，控制颅内压是影响神经外科患者预后的重要因素。渗透疗法一直是临床中控制颅内高压的重要选择。甘露醇作为经典的渗透药物，其严重的副作用也逐渐受到重视，因此寻找更安全有效的治疗也成为国内外研究的热点。目的：针对高渗盐水（hypertonicsaIine，lHS）在各种神经外科疾病引起的颅高压治疗中的研究和Hs的合理使用作一综述。内容：主要阐述近年来Hs降低颅高压，改善脑水肿的作用机制和在各种神经外科疾病中的应用进展及Hs合理使用的临床经验。趋势：Hs能有效地扩充血容量，改善脑灌注及全身血流状态，降低颅内压，逐渐取代传统治疗——甘露醇，在颅高压治疗中正日益发挥着重要的作用。

Background. Persisting cerebral edema causes intracranial hypertension and is associated with poor patient outcome. The treatment of intracranial hypertension is complex and multimodal. Osmotherapy is the most important option for the neurosurgeons and neuroanesthesiologists. Currently, mannitol is widely recognized as the ＇gold-standard＇ for treating intracranial hypertension, but its side effects are increasingly reported. Intensive researches were performed to find a more safe and effective agent for the management of ICR Objective. To review and summarize the use of hypertonic saline in controlling intracranial hypertension caused by various neurosurgical diseases. Content. The review mainly summarizes hypotheses about mechanisms of action, related application of HS in neurosurgical practice and experiences about possible dosage of HS. Conclusion. HS provides volume expansion and may improve cerebral perfusion pressure and systemic hemodynamics. Thus, HS has emerged as an alternative to mannitol and provides a new promising therapy for the treatment of cerebral edema and intracranial hypertension.