Brain injury and drug therapy in high-altitude environment: research advances / 国际药学研究杂志

Altitude sickness is a common disease caused by hypotension and hypoxia due to low pressure when people move from the plain to the plateau, which causes injury to the respiratory system, cardiovascular system, and ner- vous system. The brain tissue is very sensitive to the decrease in oxygen partial pressure, which can easily cause neuro- nal dysfunction and even lead to neuron apoptosis. The partial pressure of oxygen in the plateau environment is low, and an effective way to improve the host defense ability is to develop anti-hypoxia drugs that improve the ratio of oxyen utiliza- tion. This paper reviews and summarizes the clinical symptoms of the nervous system in the high-altitude environment, including high-altitude headache, acute mountain sickness and high-altitude cerebral edema, as well as the pathophysio- logical molecular mechanisms and related drug treatments, so as to develop the effective new drugs of anti-hypoxia brain damage and to guide the rational use of clinical scientific drugs.

Dialysis disequilibrium syndrome: A preventable fatal acute complication

Dialysis disequilibrium syndrome (DDS) is a neurological disorder with varying severity that is postulated to be associated with cerebral oedema. We described a case of DDS resulting in irreversible brain injury and death following acute haemodialysis. A 13-year-old male with no past medical history and weighing 30kg, presented to hospital with severe urosepsis complicated by acute kidney injury (Creatinine 1422mmol/L; Urea 74.2mmol/L, Potassium 6.3mmol/L, Sodium 137mmol/L) and severe metabolic acidosis (pH 6.99, HC03 1.7mmol/L). Chest radiograph was normal. Elective intubation was done for respiratory distress. Acute haemodialysis performed due to refractory metabolic acidosis. Following haemodialysis, he became hypotensive which required inotropes. His Riker's score was low with absence of brainstem reflexes after withholding sedation. CT Brain showed generalised cerebral oedema consistent with global hypoxic changes involving the brainstem. The symptoms of DDS are caused by water movement into the brain causing cerebral oedema. Two theories have been proposed: reverse osmotic shift induced by urea removal and a fall in cerebral intracellular pH. Prevention is the key to the management of DDS. It is important to identify high risk patients and haemodialysis with reduced dialysis efficacy and gradual urea reduction is recommended. Patients who are vulnerable to DDS should be monitored closely. Low efficiency haemodialysis is recommended. Acute peritoneal dialysis might be an alternative option, but further studies are needed.

Manitol versus solución salina hipertónica en neuroanestesia / Mannitol versus hypertonic saline solution in neuroanaesthesia

Background: Hyperosmolar therapy with mannitol or hypertonic saline solution is the main medical strategy for the clinical management of intracranial hypertension (IH) and cerebral oedema. IH and cerebral oedema are usually the result of acute and chronic brain injuries such as severe head trauma, ischaemic stroke, intracerebral haemorrhage, aneurismal subarachnoid haemorrhage, tumours and cerebral infections. Objective: We conducted this research in order to assess the benefits and side effects of osmotherapy and to identify the current trends in the management of IH and cerebral oedema. These two conditions worsen neurological outcomes and are the major cause of mortality in neurological patients. In this article we show the current evidence supporting the use of HTS and mannitol, and examine the question of which of the two agents is considered the best option for the medical treatment of IH. We review the efficacy data for HTS compared with mannitol in terms of clinical considerations. Conclusion: Data availability is limited because of small sample sizes, inconsistent methods and few prospective randomized comparative studies, although both agents are effective and have a reasonable risk profile for the treatment of cerebral oedema and IH. Currently, several trials show that HTS could be more effective in reducing ICP, with longer lasting effects. HTS maintains systemic and cerebral haemodynamics.

Antecedentes: La terapia hiperosmolar con manitol o solución salina hipertónica (SSH) es la principal estrategia médica para el manejo clínico de la hipertensión intracraneal (HIC) y del edema cerebral. La HIC y el edema cerebral suelen ser las consecuencias de lesiones cerebrales agudas y crónicas tales como el trauma craneoencefálico severo, el accidente cerebrovascular isquémico, la hemorragia intracerebral, la hemorragia subaracnoidea aneurismática, y los tumores e infecciones cerebrales. Ambas entidades, contribuyen a peores resultados neurológicos y producen mayor mortalidad en los pacientes neurocríticos. Objetivo: Realizamos esta investigación con el objetivo de valorar lo efectos beneficiosos y secundarios de la osmoterapia y cuáles son las tendencias actuales para el manejo de la HIC y del edema cerebral. En el presente artículo mostramos la evidencia actual que soporta a la SSH y al manitol y cuál se considera la mejor opción como terapia médica en el tratamiento de la HIC. Revisamos la eficacia de los datos para SSH frente a manitol hablando sobre sus consideraciones clínicas. Conclusión: La disponibilidad de los datos es imitada por las muestras pequeñas, métodos inconsistentes y pocos estudios aleatorizados prospectivos comparativos, y aunque ambos agentes son eficaces y tienen un perfil de riesgo razonable para el tratamiento del edema cerebral y en la HIC, en la actualidad varios ensayos demuestran que la SSH podría ser más eficaz en la reducción de la PIC y por más tiempo. La SSH mantiene la hemodinamia sistémica y cerebral.

A Randomized Trial of Ligustrazini Hydrochlorioi in the Treatment of Viral Encephalitis in Children.

Introduction: Chuanxiong is a herb used in traditional Chinese medicine for the Treatment of viral encephalitis. In animal studies it has shown to inhibit the synthesis and activity of Thromboxane (TXA2) and abate the imbalance between Thromboxane (TXA2) and Prostacyclin (PGI2). As a result, cerebral edema, ischemia and hypoxia could be improved. The aim of this study is to evaluate its effect in the treatment of viral encephalitis in children. Methodology: Ninety-nine patients with viral encephalitis were randomly divided into two groups. Ligustrazini Hydrochlorioi (LH) consisting of 51 cases (males 30, females 21; age 5 years and nine month±8 years and 2month) was given LH 4mg/kg per day in 100- 300mls of 10% glucose and infused intravenously over a three to four hour period, for 7 days as a course of treatment. A control groups of 48 cases(males 31, females 17; age 5 years and three month±4 years and three month) received the conventional treatment of Vitamin C(2.0-3.0g), Coenzyme A(100u) and Adenosine Triphosphate(ATP)(40mg) in 100-300 mls of 10% glucose infused intravenously daily for 7 days. Results: The total response rate in the LH group and the control group were 94.12% and 68.75% respectively (u=3.271 p<0.05). The average time to improvement was 4.29±1.41 days and 7.31±2.66 days respectively. No adverse effect was observed in both groups. Conclusion: We conclude that LH is an effective, safe and well tolerated treatment for children encephalitis.