重型颅脑损伤高渗治疗的思考

Hypertonic solution for the treatment of severe traumatic brain injury

脑水肿是颅脑损伤后引起颅内高压的重要原因,可导致患者预后不良。高渗治疗通过静脉输注高渗制剂,在颅内建立渗透压梯度,以减轻脑水肿。这一疗法仍是目前颅脑损伤指南中控制颅内高压的主要推荐治疗方案。本文简要回顾了高渗治疗的作用机制,介绍了常用高渗制剂甘露醇与高渗盐水的理化特性与使用方案,并综合分析了临床实践中需要注意的问题。

Brain swelling after trauma leads to significant intracranial hypertension which is associated with increased morbidity and mortality in patients with severe traumatic brain injury（ s TBI）. Hyperosmolar therapy,utilizing the infusion of a hyperosmolar solution to build an osmotic gradient to extract the water out of the brain,remains the mainstay of the treatment based on guidelines for s TBI. In this paper,we introduce the basic mechanisms of hyperosmolar therapy,summarize the physiological properties of hyperosmolar agents,as well as notable issues in clinical practice.