中国神经再生研究(英文版) ›› 2015, Vol. 10 ›› Issue (12): 1938-1939.doi: 10.4103/1673-5374.169620

• 观点:脑损伤修复保护与再生 • 上一篇    下一篇

高渗盐水促进头部创伤恢复

  

  • 收稿日期:2015-09-29 出版日期:2015-12-30 发布日期:2015-12-30

Hypertonic saline: a brief overview of hemodynamic response and anti-inflammatory properties in head injury

Matheus Fernandes de Oliveira*, Fernando Campos Gomes Pinto   

  1. Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, IAMSPE, São Paulo, Brazil (de Oliveira MF)
    Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil (Pinto FCG)
  • Received:2015-09-29 Online:2015-12-30 Published:2015-12-30
  • Contact: Matheus Fernandes de Oliveira, M.D.,mafernoliv@yahoo.com.br.

摘要:

高渗盐水已经在多种医疗领域内得到应用,从肺病,如哮喘,囊性纤维化到内分泌学科,如低钠血症,尤其是在急诊医学的创伤和炎症/传染性疾病中应用最为广泛。它们可以由3%或7.5%氯酸钠构成,并依据摩尔渗透压浓度有所不同。到目前为止,3%溶液是被最广泛研究和应用的解决方案。
在与外伤有关死亡病例中有超过60%的致病原因是颅脑损伤,而颅脑损伤中20%患者有出血和休克现象。低血压,即使持续时间非常短暂,也是引发继发性脑损伤的重要原因,并会加剧病变结果。文章主要指出了高渗盐水在创伤性脑损伤中的应用。他们表示初始创伤后,脑损伤第二阶段开始。继发性脑损伤有多重不同病因,包括水肿、缺血、兴奋性毒性和炎症。当神经元被过量神经递质破坏性刺激,特别是谷氨酸刺激时会发生兴奋性毒性。目前一些研究指出高渗盐水低容积输液能够在损伤后改善脑和全身血流动力学参数。高渗盐水治疗能够增强细胞介导的体内免疫应答,并诱导免疫调节作用,该作用可以降低创伤后败血症的危险。几个实验和临床数据都表示使用高渗盐水不仅可以在创伤性脑损伤慢性复苏中应用,在急性期解决炎症和免疫损伤时也有治疗效果。

Abstract:

ypertonic saline (HS) has been applied in several medical areas, from pneumology, like asthma, cystic fibrosis and bronchiolytis; endocrinology, like hyponatremia and especially in emergency medicine, being applied in traumatic and inflammatory/infectious disorders. They may be composed of 3% or 7.5% sodium chlorate, and differ in accordance to osmolarity. By far, 3% solution is the most widely studied and used solution.
Head injury is the main cause of trauma-related deaths in over 60% of cases. Hemorrhage and shock are observed in up to 20% of patients with head injuries. Hypotension, even for very brief periods, is a well-established cause of secondary brain injury, and contributes to worse outcomes. 
After the initial trauma, a second phase of brain injury begins. Secondary brain injury results from a complex sequence of events that begins just after the initial insult and continues through the acute hospitalization. Secondary brain injury results from a diverse host of etiologies, including edema, ischemia, excitotoxicity, and inflammation. Excitotoxicity occurs when a neuron is destructively stimulated with excess amounts of neurotransmitter, especially glutamate. Inflammation is increasingly recognized to be an important source of secondary brain injury. Additionally, trauma results in a dysregulation of the immune system, predisposing patients to nosocomial infections and worse outcomes. Several studies have pointed that HS is able to improve cerebral and systemic hemodynamic parameters after trauma, with lower volume infusion. HS treatment enhances cell-mediated immune responses in vivo, and elicits immunomodulatory effects that decrease the risk of posttraumatic sepsis. Several experimental and clinical data supports the use of HS not only for volemic resuscitation but to address inflammatory and immune impairments during acute phase.