神经外科降颅压药物的研究进展  

Research progress of therapeutic drugs for reducing intracranial pressure

作　　者：高一铭 姜美竹 李草 赵志刚[1] GAO Yi-ming;JIANG Mei-zhu;LI Cao;ZHAO Zhi-gang(Department of Pharmacy,Beijing Tiantan Hospital,Capital Medical University,Beijing 100071;Department of Clinical Pharmacology,School of Pharmaceutical Sciences,Capital Medical University,Beijing 100069)

机构地区：[1]首都医科大学附属北京天坛医院药学部,北京100071 [2]首都医科大学药学院临床药学系,北京100069

出　　处：《中南药学》2023年第12期3267-3273,共7页Central South Pharmacy

基　　金：北京市医院管理中心青苗计划(No.QML20230511);中国药学会医院药学专委会科研项目(No.CPA-Z05-ZC-2022-002);首都医科大学临床专科学院(系)培养基金开放课题(No.CCMU2023ZKYXZ008)。

摘　　要：颅内压(ICP)升高是神经外科中常见的临床症状,药物治疗是临床上降颅压分层管理的重要环节,多种药物可以降低颅内压,如高渗脱水剂、利尿剂、血容量扩充剂和激素等。高渗脱水剂的应用最普遍,其中甘露醇的应用时间最长,是被广泛使用的一线药物;利尿剂、血容量扩充剂单独降颅压作用较弱,多与高渗脱水剂配伍使用;糖皮质激素可用于脑水肿,治疗其他类型颅内压增高的证据有限;其他药物如苯巴比妥、乙酰唑胺等也可能起到降颅压的作用,但临床应用较少。哪一种药物的效果更好、更具应用价值,是临床需要关注的问题。本文拟就国内外降颅压相关的药物作一综述,以期为临床制订药物治疗方案提供参考。Elevated intracranial pressure(ICP)is a common clinical symptom in neurosurgery.Drug therapy is an important part of the hierarchical management of ICP reduction.A variety of drugs can reduce ICP,such as hypertonic dehydrants,diuretics,blood volume expanders,and hormones.The application of hypertonic dehydrants is the most common,among which mannitol has been used for the longest time and is the widely used first-line drug. Diuretics and blood volume expanders alone have a weak effect on reducing intracranial pressure, and are often used in combination with hypertonic dehydrants. Glucocorticoids can be used for the treatment of cerebral edema, and there is limited evidence for the treatment of other types of increased intracranial pressure. Other drugs such as phenobarbital and acetazolamide may also play a role in reducing intracranial pressure, and they are rarely used in clinical practice. Which drug has better effect and more application value is the problem that needs to be paid attention to clinically. This article reviews the drugs related to reducing intracranial pressure at home and abroad, so as to provide reference for clinical drug treatment.

关 键 词：颅内压 神经外科 药物治疗 甘露醇 高渗盐水 

分 类 号：R651.15[医药卫生—外科学]