Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Comparison of hypertonic saline treatment in meningitis with cerebral edema

뇌수막염에서 발생한 뇌부종 치료에서 고장성 식염수 비교

  • Kim, Hyung Su (Department of Pediatrics, Busan Medical Center) ;
  • Kim, Hee Ra (Department of Pediatrics, Busan Medical Center)
  • Received : 2006.08.10
  • Accepted : 2006.10.02
  • Published : 2006.12.15
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Abstract

Purpose : Cerebral edema in meningitis is a potentially complication. Hypertonic saline of various concentrations are frequently used to treat cerebral edemas in meningitis. We analyzed the safety and efficacy of osmotic therapy in cerebral edema by comparison of various hypertonic saline concentrations and mannitol. Methods : The medical records of 42 patients, who were followed up in the Department of Pediatrics, Busan Medical Center, from Jan. 2002 to Oct. 2005, were analyzed retrospectively. We measured intracranial pressure, mean flow velocity, and various laboratory parameters. Results : In cerebral edema developed in meningitis, intracranial pressure and symptoms were improved in treatment of hypertonic saline and mannitol. Serial bolus infusion of 3 percent hypertonic saline resulted in the best outcome. There was not a statistically considerable difference on the mean values of the intracranial pressure gap. On transcranial doppler, mean flow velocity was increased and pulsatilty index was decreased. Laboratory findings (osmolarity, Na, Cl, pH, lactic acid, Ca) were diffenent during the treatment period as opposed to K, Hb, bicarbonate, base excess. There was not a specific form of hypertonic saline used in meningitis treatment with cerebral edema. Conclusion : The therapy for cerebral edema in meningitis remains largely empirical. Serial bolus infusion of 3 percent hypertonic saline is better than other hypertonic salines. Various concentrations and different infusion methods of hypertonic saline statistically does not influence the result of treatment. More research aimed at improving cerebral edema treatment is needed to identify new, effective forms of treatment.

목 적 : 뇌수막염은 뇌와 척수를 둘러싸는 막의 염증으로 여름과 가을에 소아들에 호발하여 합병증이 발생하면 신경학적 후유증을 야기할 수 있는 질환이다. 뇌수막염의 합병증으로 뇌부종이 발생한 경우 증상치료로서 mannitol과 고장성 식염수가 삼투성 이뇨치료로 이용되어진다. 고장성 식염수는 다양한 농도와 투여방법이 있을 수 있는데 본 연구는 고장성 식염수의 가장 효과적이고 안전한 투여 형태에 대해 고찰하였다. 방 법 : 2002년 1월부터 2005년 10월까지 부산의료원 소아과에 입원하였던 뇌수막염환아 283명중 뇌부종이 발생했던 42명의 환아를 대상으로 하였다. 20% mannitol과 4가지 형태의 고장성 식염수로 치료하였던 5가지 투여군을 분석하였다. 증상과 징후의 호전유무, 뇌압측정치, 뇌혈류속도 측정치, 검사소견으로 효과적인 투여형태에 대해 통계적 분석을 하였다. 결 과 : 1) 환아의 평균연령은 5.34세이었으며 남녀 비율은 남아가 22명이고 여아는 20명이었다. 주된 임상양상은 발열(97%), 두통(92%), 구토(71%), 경련(47%), 기면(35%), 경부강직(35%), 복통(35%), 기침(35%), 유두부종(35%), 보챔(28%), 수두증(11%) 순으로 나타났다. 2) 증상 및 징후의 호전유무는 치료 4일째 24명이 상기증상 및 징후의 50%이상의 호전을 나타내었다. 3% 고장성 식염수 농축괴와 3% 고장성 식염수 연속적 농축괴 그리고 7.5% 고장성 식염수 연속적 농축괴의 방법이 효과적인 것으로 분석되었다(P<0.05). 3) 뇌압측정치는 5가지 방법모두 뇌압하강효과가 있는 것으로 나타났다. 3% 고장성 식염수 연속적 농축괴 주입이 뇌압하강치가 1.86 kPa로서 가장 좋은 기록이었지만 통계학적 의미는 없었다(P=0.31). 4) Transcranial doppler에 의한 MFV와 PI 측정에서는 5가지 방법 모두 MFV도의 상승과 PI 하강을 보여주었다. PI와 MFV 상에서는 5가지 방법에서 치료효과의 차이가 없는 것으로 분석할 수 있었다(P=0.59, P=0.99). 5) 치료기간동안 다양한 검사소견을 비교할 수 있는데 나트륨, 염소, 수소이온농도, 젖산, 몰삼투압농도, 칼슘은 차이가 날 수 있는 것으로 관찰되었고(P<0.05), 칼륨, 혈색소, 중탄산염, 염기 과다는 차이가 없는 것으로 분석되었다. 나트륨, 염소, 몰 삼투압농도는 약간 상승되었고 수소이온농도, 젖산, 칼슘은 약간 하강하였으나 큰 변화는 없었다. 결 론 : 뇌수막염에서 뇌압상승, 뇌부종이 발생한 환아의 증상치료로서 고장성 식염수가 다양한 농도와 투입방법이 고려되어 질 수 있다. 본 연구의 결과로는 3% 고장성 식염수 연속적 농축괴의 투여방법이 가장 우수해 보이나 무작위 추출이 아니며 여러 가지 결과를 종합할 때 가장 우수하다고 하기에는 무리가 있었다. 향후 보다 더 많은 집단을 대상으로 한 무작위 추출의 다양하고 종합적인 연구가 필요할 것으로 사료된다.

Keywords

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