薛丽平+梁新强+刘亚虎

【摘要】 颅脑损伤、脑肿瘤、脑出血及蛛网膜下腔出血等许多神经外科疾病均能引起脑水肿，进而引起颅内压（intracranial pressure，ICP）增高。颅内压增高被认为是急性脑水肿患者死亡的主要原因，ICP的有效控制与患者预后有着密切的联系。作为临床上经典的降颅内压药物，甘露醇的疗效备受认可，但其严重的副作用也逐渐受到重视，寻找更加安全有效的治疗成为目前研究的热点。本研究表明高渗盐水可以有效治疗脑水肿，降低ICP，尤其是对甘露醇不能控制的高颅压也能起效，并且高滲盐水在治疗上可以避免甘露醇脱水治疗所引起的副作用如急性肾功能不全和反跳性脑水肿等，高渗盐水在治疗急性脑水肿比传统的甘露醇疗法更具优势。本文对高渗盐水在急性脑水肿和ICP增高的治疗应用中作一综述。

【关键词】 高渗盐水； 脑水肿； 颅内压增高

【Abstract】 Craniocerebral trauma，brain tumor，cerebral hemorrhage and subarachnoid hemorrhage and many other diseases in Department of Neurosurgery can cause cerebral edema，and further cause intracranial pressure （intracranial pressure，ICP） increased.Intracranial hypertension is considered main cause of death in patients with acute cerebral edema， effective controlling intracranial pressure is an import prognostic factor in patients with acute cerebral edema.As a classic drug for reducing intracranial pressure，the efficacy of mannitol has been recognized， but its serious side effects have been gradually seen，and the search for more safe and effective treatment has become the focus.The research indicate that hypertonic saline can not only effectively control cerebral edema and reduce the ICP，especially for high intracranial pressure that mannitol can not control，but it can avoid the side such as acute renal failure and relapse of cerebral edema due to mannitol dehydration treatment.In the treatment of acute cerebral edema， hypertonic saline get more advantages.This article reviews the application of hypertonic saline in the treatment of brain edema and controlling intracranial pressure.

【Key words】 Hypertonic saline； Cerebral edema； Intracranial hypertension

First-authors address：Guangxi Medical College，Nanning 530021，China

doi：10.3969/j.issn.1674-4985.2017.34.042

许多神经外科疾病均能引起脑水肿，进而引起颅内压（intracranial pressure，ICP）增高。颅内压增高被认为是急性脑水肿患者死亡的主要原因，ICP的有效控制与急性脑水肿患者预后有着密切的联系[1-4]。控制ICP是一个复杂的多元化治疗，包括机械通气、脱水疗法、脑脊液引流、外科减压等[5]。甘露醇作为临床上经典的降颅内压药物其疗效备受认可，但其具有一定的局限性且长期使用可引起急性肾功能不全和反跳性脑水肿等严重的副作用。自1988年高渗盐水（Hypertonic saline，HS）首次被报道用于治疗对甘露醇无法控制的难治性颅内高压以来，HS在临床的应用日益广泛。……