Page 1 of 13

European Journal of Business &

Social Sciences

Available at https://ejbss.org/

ISSN: 2235-767X

Volume 07 Issue 05

May 2019

Available online:https://ejbss.org/ P a g e | 580

UDC: 616.831-008.918: 617.51-001-005.98: 616-085

Effects Of Mannitol And Hypertonic Solution Of Sodium Chloride On

Intracranial Pressure In Patients With Brain Injury

MurotovTemur Malik Nizomovich, Jumanazarov Farrux Fayzullaevich,

Juraev Pirnazar Bahodirovich

TashkentMedicalAcademy

The Department of Anesthesiology and Resuscitation

Uzbekistan

Purpose:study the comparative efficacy of using a 15% solution of

mannitol and a hypertonic 7% solution of sodium chloride in the complex

treatment of patients with TBI.

Material and methods:It examined 20 patients aged from 18 years to 65

years with a variety of traumatic-brain injuries, and depressed level of

consciousness from 4 to 11 points on the scale of coma Glasgow

Results:infusion ofmannitol in the indicated dosage led to a decrease in

ICP after 30 minutes by42, 3%, and after120minit remained below the initial

data by23,9%.Infusion of a7% solution ofNaClby 30 minutes led to a decrease

in ICP by 55.4%, and by the end of 120 minICPremained below the initial

data by 39.9%.

Findings:Thedecrease in ICPwithin the limits of 30 and 120 minutes after

the introduction of hyperosmolar solutions is more pronounced with IV

injection of 7%NaCl solutionrelative to 15% Mannitol in calculated dosages,

which must be borne in mind in patients with concomitant cardiac and renal

pathology.

Key words:TBI, brain edema, CPP,ICP,NaCl,mannitol,

The brain from many points of view (anatomy, cellular organization and

function) - complex organ. When it is damaged, the response is also complex

Page 2 of 13

European Journal of Business &

Social Sciences

Available at https://ejbss.org/

ISSN: 2235-767X

Volume 07 Issue 05

May 2019

Available online:https://ejbss.org/ P a g e | 581

and multifaceted [1]. Traumatic brain injury (TBI) is defined as a change in

brain function or its other structures, pathology, caused by external force [2].

General pathological effects of brain injury include

hematoma,Subarachnoidhemorrhage, contusion and diffuse axonal

damage[1,3]. They differ in severity from mild to severe TBI. Severe head

injury has a high mortality rate up to 30-60% in studies on unselected

populations [4].Survivors have a significant burdenphysical, mental,

emotional and cognitive disorders that disrupt the lives of people their families

and bearhuge costs for society[5].TBI is a growingproblem of public health in

significant proportions. More than 50 million cases of TBI are recorded at the

international level every year [6] and it is estimated that about half of the

world's population will have one or more TBI during their lifetime. In the

European Union up to 1.5 million people arehospitalized and 57,000 die each

year due to traumatic brain injury [7]. TBI is the leading cause of death among

young people and disability among of all ages [8] and accounts for 30% of all

deaths associated with injuries. [5,7,9].

TBI can be divided into primary and secondary injury [3,10]. The primary

injury is caused by direct external influence of. mechanical force, leading to

disturbances of the blood-brain barrier (BBB) and blood vessels that

contribute to edema [3,11,12,13,14]. Secondary injury refers to a cascade of

delayed pathological processes that can last for hours of days and play so

important role in morbidity and mortality and as a result of head injury and is

characterized by ischemia, disturbance of BBB and brain edema[3,8,13], what

It is associated with activation of microglia and astrocytes in the brain that

produce tons of cytokines and chemokines, and attraction of peripheral

immune cells to the brain [3,10, 12,15,16].

Page 3 of 13

European Journal of Business &

Social Sciences

Available at https://ejbss.org/

ISSN: 2235-767X

Volume 07 Issue 05

May 2019

Available online:https://ejbss.org/ P a g e | 582

Cerebral edema after TBI leads to devastating damage of brain structures.

[13]. TBI is characterized by mixed cytotoxic and vasogenic edema,

mechanism conducive to general cerebral edema [17,18].Treatment of

cerebral edema aimed at extracting excess water from brain tissue into the

intravascular space. This is usually achieved with osmolar therapy.

The severityof cerebral edema is directly proportional to the increase in

ICP. Increased intracranial pressure, reduced cerebral perfusion pressure [19].

These processes lead to impaired cerebral circulation and occurs cerebral

ischemia.

It is necessary to clearly understand the nature of the disorders of the

blood-brain barrier, brain metabolism, and cerebral bloodstream to properly

exercise adequate treatment. The blood-brain barrier restricts the flow only for

fat-soluble substances, although water can move freely [20]. Considering this

concept is crucial for understanding how mannitol and hypertonic solution

help reduce brain swelling. According to Butterworth et al. auth., "The

movement of a particular substance through the blood-brain barrier is

regulated at the same time in size, charge, lipid solubility and degree of

protein binding in the blood. ". The largemoleculsof mannitol are unable to

cross the blood-brain barrier, and sodium ions limited in their passage. When

a large amount of mannitol or hypertonic saline falls into blood, the flow of

these substances cannot cross the BBB. This creates plasma hypertonus in the

vascular network of the brain, which leads to an increase in the osmotic

gradient, which leads to the movement of water from brain parenchyma in

blood vessels [20].