早期应用甘露醇治疗高血压脑出血的临床研究

Study the Influence of Mannitol on Early Enlargement of Hematoma in Hypertensive Cerebral Hemorrhage

目的探讨高血压脑出血早期应用甘露醇对继续出血的影响。方法选择90例早期高血压脑出血患者，随机分为A、B、C3组各30例，其中A组患者24h内接受常规量甘露醇250ml治疗，静脉点滴，1次／（8—12）h；B组24h内接受半常规量甘露醇125ml治疗，静脉点滴，1次／（8—12）h；C组24h内仅应用呋塞米20-40mg，静推，1杉（6—12）h。观察3组患者血肿扩大情况及神经功能缺损评分。结果A组与B、C组血肿扩大情况间差异均有显著性意义（P〈0．05）。治疗后神经功能缺损评分A组与B、C组间差异亦有显著性意义（P〈0．05）。结论高血压脑出血患者发病24h内不适当应用甘露醇可增加早期血肿发生率，从而加重病情。半常规量则安全、可靠。

Objective To stduy the influence of mannitol on early enlargement of hematoma in hypertensive cerebral hemorrhage. Methods Ninety patients with hypertensive supratentorial non - thalamic cerebral hemorrhage and light intracranial hypertension, and with less than 50ml of hematoma volume were randomly divided into three group in which mannitol and lasix was used within 24h. Cranial CT was redone at 24h. If the volume of hematoma increased by 33% , it should be considerd as early enlargement of hematoma. The influence of using mannitol within 24h after the onset on early enlargement of hematoma was analyzed. Results 13 patients in the group in which mannitol was used within 24h after the onset had early enlargement of hematoma, 4 patients in the group using half- nmnnitol and 5 in the group using lasix had hematoma enlargement. There was significant difference between them. The integral comparison of nerve function defect in them was similar. Conclusion Improper use of mannitol within 24h after the onset may increase the incidence of early enlargement of hematoma in the patients with hypertensive cerebral hemorrhage, and exacerbate the patient＇s conditions. Mannitol should not be used blindly, half- mannitol was high safety.