新生儿脑水肿与颅内高压的治疗

Treatment of brain edema and intracranial hypertension in newborn

新生儿脑水肿与颅内高压是各种危急重症常见的并发症,常比原发病更危险,是引起新生儿致残与致死的重要原因。新生儿虽有前囟和未闭的颅缝,但代偿能力远比成年人差,极易发生颅内高压。这应引起新生儿科临床医师的高度重视。颅内高压发生时,应保证有效脑灌注压(CPP)和脑血流量(CBF),避免颅内高压引起脑组织缺血、缺氧所致脑损伤加重或继发性脑损伤的发生。高渗溶液是减轻脑水肿,降低颅内高压最常用的治疗措施,高渗盐水减轻脑水肿与降低颅内高压的疗效优于甘露醇。此外,临床对脑水肿与颅内高压的治疗,还应注意避免一些有害治疗加重脑损伤。

Brain edema and intracranial hypertension are common complications in all critical severe ill patients. It would cause disability and death, so it can be more dangerous than primary disease. Although there are former fontanel and unclosed cranial suture in an infant, the compensatory reserves of volume- pressure compliance is far worse than that in adults. This phenomenon should be paid more attention by neonatologist. Cerebral perfusion pressure （CPP） and cerebral blood flow （CBF） should be guaranted to avoid cerebral ischemic hypoxia or secondary brain injury induced by intracranial hypertension. Hyperosmolar solutions particularly appear to be an appealing addition to the current therapeutic avenues for brain edema. The curative effects of hypertonic saline are better than those of mannitol which have been improved by a variety of researches. In addition, the treatment of brain edema also should avoid some detrimental treatments that aggravate the brain damage.