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Abstract：
Osmotherapy constitutes a first-line intervention for intracranial hypertension management. However, hyperosmolar solutes exert various systematic effects, among which their impact on systemic haemodynamics is poorly clarified. This review aims to appraise the clinical evidence of the effect of mannitol and hypertonic saline (HTS) on cardiac performance in neurosurgical and neurocritical care patients.
A database search was conducted to identify randomized clinical trials and observational studies reporting HTS or mannitol use in acute brain injury setting. The primary end-points were alterations of cardiac output (CO) and other haemodynamic variables, while the impact of osmotic agents on intracranial pressure, brain relaxation, plasma osmolality, electrolyte levels and urinary output constituted secondary outcomes.
Eight studies, enrolling 182 patients in total, were included. HTS exerted a more profound cardiac output augmentation than mannitol, but no distinct difference between groups occurred. Central venous pressure, stroke volume and stroke volume variation were favourably affected by both osmotic agents, whilst the reported changes in blood pressure were inconclusive. HTS infusion yielded a larger intracranial pressure reduction than mannitol but had an equivalent effect on brain relaxation. Mannitol presented a more potent diuretic effect than HTS. Effect on serum osmolality was alike in both osmotic agents, but contrary to HTS-promoted hypernatraemia, mannitol use induced transient hyponatraemia.
Mannitol or HTS administration seems to induce an enhancement of cardiac performance; being more prominent after HTS infusion. This effect combined with mannitol-induced enhancement of diuresis and HTS-promoted increase of plasma sodium concentration could partially explain the effects of osmotherapy on cerebral haemodynamics.
A database search was conducted to identify randomized clinical trials and observational studies reporting HTS or mannitol use in acute brain injury setting. The primary end-points were alterations of cardiac output (CO) and other haemodynamic variables, while the impact of osmotic agents on intracranial pressure, brain relaxation, plasma osmolality, electrolyte levels and urinary output constituted secondary outcomes.
Eight studies, enrolling 182 patients in total, were included. HTS exerted a more profound cardiac output augmentation than mannitol, but no distinct difference between groups occurred. Central venous pressure, stroke volume and stroke volume variation were favourably affected by both osmotic agents, whilst the reported changes in blood pressure were inconclusive. HTS infusion yielded a larger intracranial pressure reduction than mannitol but had an equivalent effect on brain relaxation. Mannitol presented a more potent diuretic effect than HTS. Effect on serum osmolality was alike in both osmotic agents, but contrary to HTS-promoted hypernatraemia, mannitol use induced transient hyponatraemia.
Mannitol or HTS administration seems to induce an enhancement of cardiac performance; being more prominent after HTS infusion. This effect combined with mannitol-induced enhancement of diuresis and HTS-promoted increase of plasma sodium concentration could partially explain the effects of osmotherapy on cerebral haemodynamics.
摘要：
渗透疗法是颅内高压管理的一线干预措施。然而,高渗溶质发挥各种系统作用，其中它们对全身血流动力学的影响尚不清楚。这篇综述旨在评估甘露醇和高渗盐水（HTS）对神经外科和神经重症监护患者心脏功能影响的临床证据。
进行了数据库搜索，以确定报告在急性脑损伤中使用HTS或甘露醇的随机临床试验和观察性研究。主要终点是心输出量（CO）和其他血液动力学变量的改变，而渗透剂对颅内压的影响，大脑放松，血浆渗透压,电解质水平和尿量构成次要结局.
8项研究,共招募182名患者，包括在内。HTS比甘露醇产生更深刻的心输出量增加，但组间无明显差异。中心静脉压,两种渗透剂对每搏输出量和每搏输出量的变化都有有利的影响，而报告的血压变化尚无定论。HTS输注比甘露醇产生更大的颅内压降低，但对脑松弛具有同等作用。甘露醇表现出比HTS更有效的利尿作用。两种渗透剂对血清渗透压的影响相似，但与HTS促进的高钠血症相反，使用甘露醇引起短暂性低钠血症。
甘露醇或HTS施用似乎诱导心脏性能的增强;在HTS输注后更显著。这种作用与甘露醇诱导的利尿增强和HTS促进的血浆钠浓度增加相结合，可以部分解释渗透疗法对脑血流动力学的影响。
进行了数据库搜索，以确定报告在急性脑损伤中使用HTS或甘露醇的随机临床试验和观察性研究。主要终点是心输出量（CO）和其他血液动力学变量的改变，而渗透剂对颅内压的影响，大脑放松，血浆渗透压,电解质水平和尿量构成次要结局.
8项研究,共招募182名患者，包括在内。HTS比甘露醇产生更深刻的心输出量增加，但组间无明显差异。中心静脉压,两种渗透剂对每搏输出量和每搏输出量的变化都有有利的影响，而报告的血压变化尚无定论。HTS输注比甘露醇产生更大的颅内压降低，但对脑松弛具有同等作用。甘露醇表现出比HTS更有效的利尿作用。两种渗透剂对血清渗透压的影响相似，但与HTS促进的高钠血症相反，使用甘露醇引起短暂性低钠血症。
甘露醇或HTS施用似乎诱导心脏性能的增强;在HTS输注后更显著。这种作用与甘露醇诱导的利尿增强和HTS促进的血浆钠浓度增加相结合，可以部分解释渗透疗法对脑血流动力学的影响。
