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Central Asian Journal of Medicine

Abstract

Objective: to study the possibility and comparative efficacy of using 15% mannitol solution and hypertensive 3.5% sodium chloride solution in the complex of treatment for patients with TBI. Material and Methods: 30 patients aged 16 to 68 years with various craniocerebral injuries and depression of the level of consciousness from 4 to 11 on the Glasgow coma scale were examined. Results: the infusion of mannitol in this dosage resulted in a reduction in ICP after 30 minutes by 42.3%, and after 120 min it fell below the baseline data by 23.9%. Infusion of a 3.5% solution of NaCl already by the 30th minute resulted in a decrease in ICP by 48.6%, and by the end of 120 minutes ICP remained below the initial data by 35.9%. Conclusions: use of 3.5% NaCI leads to a longer lasting significant increase in CPP and a prolonged decrease in ICP with respect to the 15% mannitol solution.

First Page

5

Last Page

16

References

1. Gaytur E.I., Potapov A.A. i dr. Vliyaniye arterial'noy gipotonii na techeniye i iskhody tyazheloy cherepno-mozgovoy travmy // Reanimatologiya na rubezhe XXI veka. – M., 2006. – 126 s. 2. Kachkov I.A., Potapov A.A. i dr. Regional'naya neyrotravmatologicheskaya sluzhba: Kriticheskiy analiz i sovremennyye podkhody k lecheniyu tyazheloy cherepno-mozgovoy travmy v ostrom periode. Ostryye sdavleniya golovnogo mozga // Materialy gorodskogo seminara. – M., 2011. – T. 121. – S. 34-43. 3. Martynov V.A., Zhdanovich L.G. i dr. Otek-nabukhaniye golovnogo mozga: taktika vedeniya bol'nykh // Infektsionnyye bolezni: novosti, mneniya, obucheniye. – 2018. – T. 7, №1. – S. 124-131. 4. Petrikov S.S., Solodov A.A. i dr. Vliyaniye L-lizina estsinata na vnutricherepnoye davleniye u postradavshikh s tyazheloy cherepno-mozgovoy travmoy, nakhodyashchikhsya v kriticheskom sostoyanii // Neotlozhnaya med. pomoshch'. – 2016. – №2. – S. 31-36. 5. Potapov A.A., Likhterman L.B. i dr. Sovremennyye podkhody k izucheniyu i lecheniyu cherepno-mozgovoy travmy // Klin. nevrol. – 2010. – T. 4, №1. 6. Abbott N.J. Inflammatory mediators and modulation of blood-brain barrier permeability // Cell. Mol. Neurobiol. – 2000. –Vol. 20. – P. 131-147. 7. Chen C.H., Toung T.J. et al. Effect of duration of osmotherapy on blood-brain barrier disruption and regional cerebral edema after experimental stroke // J Cereb. Blood Flow Metab. – 2006. – Vol. 26. – P. 951-958. 8. Cho J., Kim Y.H. et al. Accumulated mannitol and aggravated cerebral edema in a rat model of middle cerebral artery infarction // J. Korean Neurosurg. Soc. – 2007. – Vol. 42. – P. 337-341. 9. Fink M.E. Osmotherapy for intracranial hypertension: mannitol versus hypertonic saline // Continuum. – 2012. – Vol. 18, №3. – Р. 640-654. 10. Guidelines for the management of severe traumatic brain injury // J. Neurotrauma. – 2007. – Vol. 24 (Suppl 1). – P. S1-S106. 11. Hariri R.J. Cerebral edema // Neurosurg. Clin. North Amer. – 1994. – Vol. 5. – Р. 687-706. 12. Hartl R., Ghajar J. et al. Hypertonic hyperoncotic saline reliably reduces ICP in severely head injured patients with intracranial hypertension // Acta Neurochir. Suppl. – 1997. – Vol. 70. – Р. 126-129. 13. Hartl R., Medary M.B. et al. Hypertonic/hyperoncotic saline attenuates microcirculatory disturbances after traumatic brain injury // J. Trauma. – 1997. – Vol. 42. – Р. 41-47. 14. Hong-Ke Zeng, Qiao-Sheng Wang et al. A comparative study on the efficacy of 10% hypertonic saline and equal volume of 20% mannitol in the treatment of experimentally induced cerebral edema in adult rats // BMC Neurosci. – 2010. – Vol. 11. – Р. 153. 15. Kahle K.T., Simard J.M. et al. Molecular mechanisms of ischemic cerebral edema: Role of electroneutral ion transport // Physiology (Bethesda). – 2009. – Vol. 24. – Р. 257-265. 16. Kamel H., Navi B.B. et al. Hypertonic salineversus mannitol for the treatment of elevated intracranial pressure: a meta-analysis of randomized clinical trials // Crit. Care Med. – 2011. – Vol. 39. – Р. 554-559 17. Kaufmann A.M., Cardoso E.R. Aggravation of vasogenic cerebral edema by multiple-dose mannitol // J. Neurosurg. – 1992. – Vol. 77. – Р. 584-589. 18. Kerwin A.J., Schinco M.A. et al. The use of 23.4% hypertonic saline for the management of elevatedintracranial pressure in patients with severe traumatic brain injury: a pilot study // J. Trauma. – 2009. – Vol. 67. – Р. 277-282. 19. Marko N.F. Hypertonic saline, not mannitol, should be considered gold-standard medical therapy for intracranial hypertension // Marco Crit. Care. – 2012. – Vol. 16. – Р. 113. 20. McManus M.L., Soriano S.G. Rebound swelling of astroglial cells exposed to hypertonic mannitol // Anesthesiology. – 1998. – Vol. 88, №6. – Р. 1586-1591. 21. Michinaga Sh., Koyama Yu. Pathogenesis of brain edema and investigation into anti-edema drugs // Int. J. Mol. Sci. – 2015. – Vol. 16. – P. 9949-9975. 22. Mortazavi M.M., Romeo A.K. et al. Hypertonic saline for treating raised intracranial pressure: literature review with meta-analysis // J. Neurosurg. – 2012. – Vol. 116. – Р. 210-221. 23. Nag S., Manias J.L. et al. Pathology and new players in the pathogenesis of brainedema // Acta Neuropathol. – 2009. – Vol. 118. – Р. 197-217. 24. Nakayama S., Kramer G.C. et al. Infusion of very hypertonic saline to bled rats: membrane potentials and fluid shifts // J. Surg. Res. – 1985. – Vol. 38. – Р. 180-186.25. Piper B.J., Harrigan P.W. Hypertonic saline in paediatric traumatic brain injury: a review of nine years’ experience with 23,4% hypertonic saline as standard hyperosmolar therapy // Anaesth. Intens. Care. – 2015. – Vol. 43. – Р. 2. 26. Polderman K.H. Induced Hypothermia and fever control for prevention and treatment of neurological injuries // Lancet. – 2008. – Vol. 371. – Р. 1955-1969. 27. Puri Sh.K., Bihar P. Cerebral Edema and its Management // MJAFI. – 2003. – Vol. 59. – P. 326-331. 28. Simard J.M., Kent T.A. et al. Brain edema in focal ischemia: Molecular pathophysiology and theoretical implications // Lancet Neurol. – 2007. – Vol. 6. – P. 258-268. 29. Stubbe H.D. Salt or sugar on the brain: does it matter except for taste? // Crit. Care Med. – 2011. – Vol. 39. – P. 601-602. 30. Thrane A.S., Thrane R.V. et al. Reassessing the role of astrocytes in brain edema // Trends Neurosci. – 2014. – Vol. 11. – P. 620-628. 31. Torre-Healy A., Marko N.F. et al. Hyperosmolar therapy for intracranial hypertension // Neurocrit. Care. – 2011. – Vol. 17. 32. Walker K.R., Tesco G. Molecular mechanisms of cognitive dysfunction following traumatic brain injury // Front. Aging Neurosci. – 2013. – Vol. 5. – P. 29.

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