高渗盐水治疗脑水肿和颅高压的机制
罗自强1，岳少杰2，余小河2
基金项目：高等学校博士学科点专项科研基金资助课题（20090162110016);国家自然科学基金金资助课题(81070970) 作者简介：罗自强（1962年-），男，教授，主要研究方向：呼吸生理和脑损伤保护.

（1. 中南大学基础医学院生理学系，长沙 410013； 2. 中南大学湘雅医院新生儿科，长沙 410008）
摘要：高渗溶液是减轻脑水肿、降低颅高压最常用的治疗措施。随着对高渗盐水(hypertonic saline，HTS) 治疗脑水肿和颅高压研究的深入，HTS展现出不同于甘露醇高渗溶液治疗脑水肿和颅高压的作用优势。HTS治疗脑水肿的机制并未完全阐明，其可能的治疗机制涉及渗透性作用、以及改善脑组织灌流、抑制炎症反应、下调水通道蛋白4的表达和促进谷氨酸神经递质回收等多种非渗透机制。
关键词：脑水肿；高渗盐水；甘露醇；颅高压
中图分类号：R651
Mechanisms of hypertonic saline solutions in treatment of 15 cerebral edema and intracranial hypertension
LUO Ziqiang1, YUE Shaojie2, YU Xiaohe2
(1. Department of phsiology,Xiangya school of medicine,Central South University,Changsha 410013; 2. Department of Neonatology,Xiangya hospital,Central South University,Changsha,410008)

Abstract: Hypertonic solution has been the mainstay therapy in clinical practice for the treatment of cerebral edema and intracranial hypertension. Many experimental and clinical studies regarding the use of hypertonic saline (HTS) have suggested that HTS is superior to mannitol in cerebral edema treatment and intracranial pressure reduction. The mechanisms of action of HTS for treatment of cerebral edema, however, have not been fully demonstrated. The possible  mechanisms of action of HTS are the osmotic effect and non-osmotic effect. The non-osmotic mechanisms include the improvement of the cerebral blood flow, the inhibition of inflammatory reaction, the down-regulation of the aquaporin 4 expression and the promotion of the glutamate neurotransmitter recycling.
Key words: cerebral edema；hypertonic saline；mannitol；ntracranial hypertension