高渗盐水能在肿瘤开颅手术中实现更好的脑松弛：最新的系统网络荟萃分析

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Journal of Taibah University Medical Sciences Pub Date : 2024-09-19 DOI:10.1016/j.jtumed.2024.09.001

Khairunnisai Tarimah MD , Lalu B. Bramawangsa MD , Christian J. Suhardi MD , Elvan Wiyarta MD , Dewi Y. Bisri MD

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引用次数: 0

摘要

背景脑肿瘤开颅手术需要通过降低颅内压（ICP）使大脑松弛。本研究旨在更新之前的研究，以确定使用高渗盐水（HTS）和甘露醇来降低接受开颅手术的成年脑肿瘤患者ICP的效果和安全性。方法为了确定比较高渗盐水和甘露醇的随机对照试验（RCT），我们根据《系统综述和荟萃分析首选报告项目》指南进行了系统性文献检索，检查了五个数据库中 2013 年至 2023 年 12 月的记录。主要结果是脑松弛，次要结果是脑灌注压（CPP）、尿量（UO）、液体输入、平均动脉压（MAP）和血浆钠。荟萃分析包括常规荟萃分析、贝叶斯荟萃分析、试验序列分析和试验质量评估。与甘露醇相比，使用 HTS 与大脑明显更放松、UO 和液体输入明显降低有关。HTS 还与 MAP 升高有明显关系。HTS 组的血浆钠明显高于甘露醇组。组间 CPP 无明显差异。试验序列分析表明，脑松弛结果具有真正意义。贝叶斯分析表明，在实现脑松弛方面，3% HTS 5 毫升/千克的疗效优于甘露醇，其次是 3% HTS 5.3 毫升/千克和 20% 甘露醇 5 毫升/千克。不过，在肿瘤开颅手术过程中使用 HTS 会增加血浆钠水平。实现脑松弛的最佳剂量似乎是每公斤体重 5 毫升的 3% HTS。

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Hypertonic saline achieves superior brain relaxation in tumor craniotomy: An updated systematic-network meta-analysis

Background

Brain tumor craniotomy requires relaxation of the brain through decreasing the intracranial pressure (ICP). Osmo-hyperosmolar therapy can be used to lower the ICP.

Objectives

This study was aimed at updating previous studies to determine the effects and safety of using hypertonic saline (HTS) and mannitol to decrease ICP in adult patients with brain tumors undergoing craniotomy.

Methods

To identify randomized controlled trials (RCTs) comparing HTS vs mannitol, we performed a systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, by examining records from 2013 to December of 2023 in five databases. The primary outcome was brain relaxation, and the secondary outcomes were cerebral perfusion pressure (CPP), urine output (UO), fluid input, mean arterial pressure (MAP), and plasma sodium. Conventional meta-analysis, Bayesian meta-insight analysis, trial-sequential analysis, and trial quality assessment were conducted.

Results

Eleven RCTs involving 593 participants were included in the meta-analysis. Use of HTS, compared with mannitol, was associated with significantly greater brain relaxation, and significantly lower UO and fluid input. HTS was also significantly associated with elevated MAP. Plasma sodium was significantly higher in the HTS group than the mannitol group. No significant difference in CPP was observed between groups. Trial sequential analysis indicated true significance for the brain relaxation outcomes. Bayesian analysis demonstrated the superiority of 3% HTS at 5 ml/kg in achieving brain relaxation, followed by 3% HTS at 5.3 ml/kg and 20% mannitol at 5 ml/kg.

Conclusions

HTS is superior to mannitol in achieving optimal brain relaxation, maintaining stable blood flow, and minimizing diuretic effects. However, use of HTS during tumor craniotomy procedures can increase plasma sodium levels. The optimal dose for achieving brain relaxation appears to be 3% HTS at 5 ml/kg body weight.

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