Hyperosmolar Therapy in the Treatment of Severe Head Injury in Children Mannitol and Hypertonic Saline
Hyperosmolar Therapy in the Treatment of Severe Head Injury in Children Mannitol and Hypertonic Saline
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DOI：
10.1097/00044067-200504000-00011
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发表时间：
2005-04-01
影响因子：
2.2
通讯作者：
Knapp, James M.
中科院分区：
文献类型：
--
作者：
Knapp, James M.
创伤性脑损伤是原发性急性损伤的结果，并且由于低血压和缺氧导致继发性损伤的发展而变得复杂。脑损伤引起的脑水肿会损害必需营养素的输送并改变正常的颅内压。门罗-凯利学说定义了颅内压稳态的原理。颅内高压的治疗旨在减少 3 个颅内室中的 1 个、脑组织、血液和脑脊液的体积。高渗疗法是治疗严重颅脑损伤导致脑水肿和颅内高压患者的一种治疗干预措施。近 90 年前首次研究了高渗溶液对脑组织的影响。从那时起，甘露醇已成为治疗颅内压升高最广泛使用的高渗溶液。高渗盐水溶液越来越多地在基础科学研究和临床研究中用作甘露醇的辅助剂。高渗溶液通过两种不同的机制有效降低颅内压：血浆扩张，导致血细胞比容降低、血液粘度降低和脑血容量减少；以及产生渗透梯度，将脑组织中的脑水肿液吸入循环中。重症监护医学协会和世界儿科重症监护协会联合会的儿科部分将之前发布的成人脑损伤治疗指南改编为儿童创伤性脑损伤治疗指南。这些指南为严重颅脑损伤儿童的治疗提供了建议，包括使用甘露醇和高渗盐水治疗颅内高压。护理严重头部损伤儿童的急性和危重症护理儿科高级执业护士应熟悉管理指南和高渗溶液的使用。本文的目的是帮助高级执业护士了解高渗疗法在儿科创伤性脑损伤治疗中的作用，并回顾现行的甘露醇和高渗盐水使用指南。
Traumatic brain injury is the result of a primary, acute injury and is complicated by the development of secondary injury due to hypotension and hypoxia. Cerebral edema due to brain injury compromises the delivery of essential nutrients and alters normal intracranial pressure. The Monroe-Kellie Doctrine defines the principles of intracranial pressure homeostasis. Treatment for intracranial hypertension is aimed at reducing the volume of 1 of the 3 intracranial compartments, brain tissue, blood, and cerebrospinal fluid. Hyperosmolar therapy is one treatment intervention in the care of patients with severe head injury resulting in cerebral edema and intracranial hypertension. The effect of hyperosmolar solutions on brain tissue was first studied nearly 90 years ago. Since that time, mannitol has become the most widely used hyperosmolar solution to treat elevated intracranial pressure. Increasingly, hypertonic saline solutions are being used as an adjunct to mannitol in basic science research and clinical studies. Hyperosmolar solutions are effective in reducing elevated intracranial pressure through 2 distinct mechanisms: plasma expansion with a resultant decrease in blood hematocrit, reduced blood viscosity, and decreased cerebral blood volume; and the creation of an osmotic gradient that draws cerebral edema fluid from brain tissue into the circulation. The pediatric section of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies adapted previously published guidelines for the treatment of adult brain injury into guidelines for the treatment of children with traumatic brain injury. These guidelines offer recommendations for the management of children with severe head injury, including the use of mannitol and hypertonic saline to treat intracranial hypertension. Acute and critical care pediatric advanced practice nurses caring for children with severe head injury should be familiar with management guidelines and the use of hyperosmolar solutions. The purpose of this article is to assist the advanced practice nurse in understanding the role of hyperosmolar therapy in the treatment of pediatric traumatic brain injury and review current guidelines for the use of mannitol and hypertonic saline.