Hypertonic saline in treatment of intracranial hypertension caused by severe cerebral trauma after decompressive craniectomy

Abstract

Objective To evaluate the effect and safety of 3% hypertonic saline (HS) in intracranial hypertension of patients with severe cerebral trauma after decompressive craniectomy. Methods Forty-eight intracranial hypertension patients suffered from severe cerebral trauma after decompressive craniectomy in our hospital from January 2014 to May 2015 were divided randomly into 3% HS treatment group and 20% mannitol (MT) treatment group (n=24). Indicators such as intracranial pressure (ICP), mean arterial pressure (MAP) and central venous pressure were observed before and 0.5, 1, 2, 3, 4, 5 and 6 h after treatment in these two groups; serum electrolyte levels (potassium, sodium, urea nitrogen and creatinine) were measured before and 1, 3, 5 and 7 d after treatment. The postoperative complications and Glasgow Outcome Scale (GOS) scores 6 months after injury were observed. Results ICP levels in both groups after treatment were quickly decreased as compared with those before treatment, with significant difference (P<0.05); HS treatment group had more quickly decreased ICP: 0.5 h after treatment, the ICP level was decreased obviously, and HS treatment could be sustained for longer times (almost 5 h) than MT treatment (3 h). HS treatment group had progressively increased MAP levels, especially 2-4 h after treatment; however, MT treatment group had no such obvious changes; MAP at the same time point between the two groups had significant difference (P< 0.05). The level of serum sodium was raised quickly and sustained at a high level after continuous administration of HS, while the opposite trend was noted after administration of MT; significant difference was noted between the two groups at the same time point (P<0.05). Urea nitrogen and creatinine levels in MT treatment group were obviously increased, especially 7 d after treatment, as compared with those in the HS treatment group (P<0.05). The HS treatment group had lower incidence of postoperative complications and higher percentage of patients with good prognosis at GOS scores 6 months after injury as compared with the MT treatment group (P<0.05). Conclusion The 3% HS can decrease intracranial hypertension in patients with severe cerebral trauma after decompressive craniectomy safely and effectively, reduce postoperative complications, and improve the prognosis of patients. Key words: Hypertonic saline; Mannitol; Severe cerebral trauma; Decompressive craniectomy; Intracranial pressure