Treatment for edema of the brain
This type of medical care should be carried out in the intensive care units and be built on the following principles of treating cerebral edema.
Correction of breathing disorders and cardiacactivities. Depending on the degree of CNS damage and the severity of the condition of patients with severe forms of edema, respiratory and cardiac disorders may be primary and secondary. When correcting them, standard methods are used.
Etiological treatment of the underlying disease. The rational treatment of brain edema is to eliminate the very reason that this edema caused. Such treatment is possible only when the root cause of the edema is precisely known. However, even eliminating the cause of edema does not necessarily lead to its elimination. In such cases, therapeutic effects must be directed to the cerebral edema itself. It should be pointed out that no method of treatment will not eliminate the swelling around the tumor, abscess or hematoma, if the primary pathological focus has not been eliminated.
Pathogenetic therapy of the edema is directed, infirst of all, to eliminate hypoxia as the most unfavorable factor contributing to the development of edema. This therapy is aimed at normalization of hemodynamics, liquor dynamics, metabolism of neurons.
In other words, therapy is aimed at correcting the main pathophysiological mechanisms (circulatory, vascular, tissue) involved in the development of brain edema.
Correction of hematocirculatory disorders includes:
1. Therapeutic measures aimed at normalizing the parameters of systemic hemodynamics. To maintain adequate perfusion of the brain, it is necessary to concentrate efforts on normalizing systemic arterial pressure by rationally administering vasoactive (dilator or constrictor) fast-acting drugs (clonidine, dibazol or caffeine sodium benzoate, etc.).
2. Purpose of calcium channel blockers. These drugs help improve brain circulation, reduce the accumulation of tissue hormones and thus ensure the stability of the brain to hypoxia. These include verapamil and its derivatives (phinoptin, isoptin), nimodipine, lidoflazin, nifedipine (corinfar), fendilin (sensid), cinnarizine (stugeron).
3. Strengthening the microcirculation of the brain by prescribing drugs that normalize the tone of blood vessels and the rheological properties of the blood. Here it is expedient to use the following vasoactive drugs: cavinton, xanthinal nicotinate (kuplamin, theonikol, ksarin), euphylline, tran-tal (agapurin), dipyridamole (quarantil), halidor, sermion (redergin), re-lipolyglyukin, heparin, indometacin (voltaren, orthophene, aspirin).
When correcting the vascular (barrier) factor, the following drugs are prescribed:
• glucocorticoids (prescribed either prednisolone or dexamethasone);
• inhibitors of proteolytic enzymes. They inactivate tissue hormones of inflammation with edema of the brain (histamine, bradykinin, trypsin, etc.). For this purpose, intracranial injection of 1-10 thousand units / kg, gondox 12-15 thousand units / kg, aminocaproic acid - 200-300 mg / kg / 24 h is introduced into / in. The course of treatment with inhibitors of proteolytic enzymes, like the rule does not exceed 5-7 days;
• drugs that stabilize cell membranes andangioprotectors. The purpose of the latter contributes to a decrease in the permeability of the wall of the vessels of the brain. This group of drugs include dicinone, troxevasin, gliwenol, venoruton, ascorutin;
• calcium channel blockers (the appointment of these drugs is mentioned above);
• immunocorrecting drugs. As immunosuppressors, steroid hormones (cortisone, hydrocortisone, prednisolone) are most often used.
Immunostimulating therapy includes the use of thymosin, T-activin, B-activin, thymogen, levamisole, propermil, B vitamins.
Correction of the tissue factor includes:
• ensuring adequate oxygenation of the blood. It is achieved by restoring and maintaining the patency of the airways, by carrying out a constant inhalation of moistened oxygen, using hyperbaric oxygenation and ventilation in some cases;
• normalization of metabolic processes in neurons of the brain. For this purpose, nootropics (nootropil, piracetam, ami-nalon, cerebrolysin, encephabol, pantogam, pyriditol, etc.) are used.
Correction of water-electrolyte exchange disorders and dehydration therapy. An important pathogenetic direction of treatment of cerebral edema is the appointment of dehydration therapy:
• osmotic diuretics (glycerol, mannitol, sorbitol, etc.);
• saluretics (lasix, furosemide, etc.);
• corticosteroids (hydrocortisone, prednisolone). It should be pointed out that the effect of steroids on cerebral edema develops slowly - the effect is detected no earlier than 24 hours after the first administration of the drug. They are more effective for local edema of the brain; In addition, it is necessary to know that prolonged use of steroids, especially in small doses, can cause an increase in brain volume and ICP;
• barbiturates (intramuscularly 10% solution of thiopental sodium at a dose of 10 mg / kg every 3 hours, daily dose to children up to 80 mg / kg).
Surgical correction of cerebral edema. When the etiological factor of cerebral edema is represented by an expansive process (hematoma, tumor, abscess, etc.), it can be interrupted only by neurosurgical intervention.
the main objective emergency care - elimination of the threat to life before transportation of the patient to a specialized medical institution for the provision of specialized medical care.
- The elimination of violations of the vital functions of the body.
- Forced diuresis is carried out bydehydration type (elimination of the liquid exceeds the administration). A 20% solution of mannitol is used at the rate of 1-1.5 g / kg / day, 10% of albumin 100 ml, and lasix 40-80 mg IV.
Note. In this situation, hypertensive glucose (40%) and urea are not used, because they penetrate the blood-brain barrier, accumulate in the brain substance, promoting its hyperhydration.
3. Correction of KHS and electrolyte blood composition according to generally accepted methods.
4. Elimination of increased blood-brain barrier permeability: prednisolone at a dose of 60-90 mg iv / 2-3 times a day, dexamethasone initially 10-12 mg IV, then 4 mg after 6 hours IM, hydrocortisone up to 1 g per day .
5. Correction of arterial hypertension: eufillin 2.4% rr - 10 ml iv, slowly, dibazol 1% rr - 2-4 ml iv, i / m or p / k, papaverine hydrochloride 2% rr - 4-6 ml IM or SC, with high blood pressure ganglion blockers are used, for example, pentamine 5% rr - 2 ml in dilution for 200-300 ml of saline in / in the drip (constant control of blood pressure is required!).
6. From the pathogenetic point of view, when the brain is swollen, funds showing the properties of hemostatics and angioprotectors are indicated. These effects are possessed by dicinone.
7. Cessation of psychomotor agitation: diazepam 0.5% rr - 2 ml w / m, droperidol 0.25% rr - 2-5 ml w / w, sodium oxybutyrate 20% rr - 10-20 ml w / in a drip for 10-15 minutes. in the dilution to 100-150 ml of physiological solution (jet injection of the calculated dose of oxybutyrate itself can cause convulsive syndrome);
8. Coping of hyperthermic syndrome (if available); convulsive syndrome (if available).
9. Improvement of cerebral metabolism and blood circulation is achieved in / in the administration of 20% of piracetam-10 ml twice a day.
10. Inhibitors of proteolytic enzymes: contrikal or trasinol slowly in / in a drip of 25,000 units per isotonic solution.
11. Oxygen therapy. Antigynxants. Glutamic acid up to 1 g IV in drip, 2-3 times a day, ATP, cytochrome C.
GZ: "Lugansk State Medical University"
Department of Internal and Family Medicine
Head. Chair: Doctor of Medicine prof. Burmak Yu.G.
Teacher: Ph.D. Ass. Smirnova M.P.