Clinical observation of hypertonic saline used for the treatment of acute intracranial hypertension in patients with hemorrhagic shock

Abstract

Objective To observe the effect of hypertonic saline complex solution (hypertonic saline plus hydroxyethyl starch, HSH) on patients with severe cerebral trauma, high intracranial pressure and shock by the measurement of the changes of the mean arterial pressure (MAP), central venous pressure (CVP) and intracranial pressure (ICP), as well as GOS score changes followed up for 6 months, in order to determine the value of HSH treatment in severe cerebral trauma, intracranial hypertension and shock. Methods Sixty patients with severe brain injury and uncorrected hemorrhagic shock were selected, while the degree of coma was assessed by using GCS score, and shock severity was estimated by using the shock index (SI) score. The patients were randomly divided into HSH group (n=30) and mannitol group (MT group, n=30). Thirty minutes, 60 min and 120 min after administration either solution, The changes of MAP, CVP and ICP were observed in two groups, and all patients were followed up for 6 months to observe the outcomes of patients. Results There were no statistically significant differences in age, gender, GCS score, SI scores, and other medication between two groups (P>0.05), and they were comparable between two groups. After resuscitation of patients in two groups, MAP and CVP were elevated, but the effect of HSH appeared sooner and higher within 30 minutes [MAP (63.1±8.8) mmHg vs. (51.0±9.3) mmHg] (P<0.05); At the same time, ICP dropped more than 10% lower [ICP (27.3±5.9) mmHg vs. (32.8±4.1) mmHg] (P<0.05), while the effect of MT appeared more slowly in hemodynamic improvement; at 120 min, the increase in MAP and reduction in ICP in HSH group were more significant than those in MT group [MAP (65.9±13.2) mmHg vs. (60.4±7.2) mmHg] (P<0.01); the ICP [ (22.2±4.7) mmHg vs. (28.1±6.1) mmHg] (P< 0.01). Followed up for 6 months, good recovery rate in HSH group was higher and poor recovery rate was lower than those in MT group. Conclusions In patients with acute intracranial hypertension and uncorrected hemorrhagic shock, the employment of hypertonic saline plus hydroxyethyl starch solution can produce faster and more effective therapy for shock and reduce intracranial pressure, improving the long-term neurological function of patients. Key words: Intracranial hypertension; Hemorrhagic shock; Hypertonic sodium chloride; Hydroxyethyl