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    高張鹽水-轉運患兒時使用安全嗎?(Hypertonic saline - safe for transport?)
    原作者: Mimi Lu,肖鋒譯 發布日期:2013-02-27
    關鍵詞:兒科急救

    Title: Hypertonic saline - safe for transport?
    題目:高張鹽水-轉運病人時使用安全嗎?
    Author 作者: Mimi Lu

    Management of the patient with intracranial hypertension represents one of the most challenging situations the emergency physician faces. Doing so in a community setting when the patient is a child is even more daunting. But devising therapies that can safely be given while the patient is being transferred to a tertiary center for definitive therapy is truly critical.
    處理顱內壓增高是急診醫生面臨的嚴峻挑戰之一,在縣級以下醫院處理兒科病人時會更具危險性。因此制定一個能在將病人轉移到上級醫院時安全使用的治療方法尤為關鍵。
     
    Fortunately, a recent study suggests that 3% saline fits this bill nicely. Given the risk of vasconstriction with hyperventilation and the risk of hypovolemia with mannitol, hypertonic saline has emerged as beneficial therapy when trying to decrease intracranial pressure (ICP) in both children and adults. 
    可幸的是,一個新的臨床研究提示3%的鹽水可以滿足這一要求。由于過度通氣造成血管收縮和甘露醇造成低容量的危險,高張鹽水已成為降低兒童和成人顱內壓的有效方法。
     
    In late 2011, the Loma Linda University Medical Center published a retrospective analysis of their experience using 3% saline during transport of children at risk of elevated ICPs. While they found the expected rise in electrolytes such as sodium, chloride and bicarbonate, importantly they found no adverse effects (such as "local effects, renal abnormalities or central pontine myelinolysis") related to the administration of hypertonic saline, even though 96% of patients received the infusion through a peripheral line.
    2011年末,羅馬林達大學醫學中心發表了一個有關轉運有顱內壓增高危險兒童使用3%鹽水的回顧性報告。雖然他們發現了在預見內的鈉,氯,和碳酸氫鈉增高,但沒有發現于注射高張鹽水有關的副作用(如局部反應,腎功異常,或腦橋中部髓鞘溶解)。96%的病人通過末梢血管接受注射。
     
    Bottom line: hypertonic saline appears to be a viable and safe option for use as therapy to decrease ICH during transport of children at risk for intracranial hypertension.
    要點:在轉運有顱內高壓危險兒童時,高張鹽水是有效安全的降低顱內壓的方法。
     
     
    Reference 參考文獻:
    Luu JL, Wendtland CL, Gross MF, et al. Three percent saline administration during pediatric critical care transport. Ped Emerg Care 2011;27(12):1113-1117.

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