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在重型创伤性脑损伤中,降低颅内压的治疗包括甘露醇、脑脊液引流、亚低温治疗以及高渗治疗等。乳酸是主要的细胞或器官水平的代谢产物,通过糖酵解及氧化磷酸化同路产生,可在病理情况下被脑组织摄取利用。动物实验中,高渗乳酸钠在小鼠创伤性脑损伤后10-15天有更好的神经认知功能。基于高渗乳酸钠兼具脑组织在缺血再灌注期(严重创伤性颅脑损伤的早期)的良好能量底物,及扩张前循环、减轻脑水肿的优点,本文进行了一项比较使用高渗乳酸钠或甘露醇降低颅内压效果的前瞻性随机对照研究,结论为对于病情较轻的患者可尝试使用高渗乳酸盐降低颅内压,其对于脑灌注压的改善更为有利。
In severe traumatic brain injury, the treatment of reducing intracranial pressure, including mannitol, cerebrospinal fluid drainage, mild hypothermia and hypertonic treatment. Lactic acid is a major cellular or organ level metabolite produced by the same pathway of glycolysis and oxidative phosphorylation, which can be taken up by the brain tissue under pathological conditions. In animal experiments, hypertonic sodium lactate has better neurocognitive function 10-15 days after traumatic brain injury in mice. Based on the fact that hypertonic sodium lactate combines the good energy substrate of brain tissue during ischemia-reperfusion period (early stage of severe traumatic brain injury) with the advantages of pre-dilation circulation and cerebral edema reduction, A prospective, randomized controlled trial of sodium lactate or mannitol in reducing intracranial pressure concluded that intracranial pressure may be reduced by hypertonic lactate in patients with less severe conditions, which is more favorable for improving cerebral perfusion pressure.