甘露醇对自发性脑出血预后的不良影响(附525例前瞻性研究及352例回顾性分析)

The side effect on mannitol to the prognosis of spontaneous cerebral hemorrhage

目的 研究甘露醇对自发性脑出血 (SCH)预后的不良影响。方法 对 1990年以前用甘露醇常规大剂量 (2 5 0 m l)治疗 35 2例 SCH患者 (A组 )进行回顾性分析 ,并对 1991年以后用甘露醇小剂量 (12 5 m l)治疗 5 2 5例 SCH患者 (B组 )行前瞻性研究。结果 (1)发病 <6小时、6～ 12小时内用药 ,A组 2 6 7例中 81例病情加重 ;B组 411例中 38例加重 ,两组比较 P <0 .0 0 1,P <0 .0 1;(2 )死亡病例 ,A组 140例中 6 6例血尿素氮 (Bun)异常 ,其中入院异常 2 4例 ,两个时程异常 42例 ;B组 94例中 2 9例 Bun异常 ,其中入院异常 19例 ,两个时程异常 10例 ,两组比较 P<0 .0 0 1。结论 大剂量甘露醇对 SCH的不良影响与其对发病 <6小时、6～ 12小时内 SCH患者脑内血肿进一步扩大及肾功能的损害有关。

Objective To study the side effect on mannitol to the prognosis of spontaneous cerebral hemorrhage (SCH).Methods 352 patients with SCH in group A given routine high dosage mannitol (250 ml) before 1990 were analysed retrospectively.525 patients with SCH in group B given little dosage mannitol (125 ml) after 1991 were analysed prospectively.Results (1)At the onset <6 h,6 h to 12 h,81 of 267 cases in group A took medicine and took a change for the worse;38 of 411 cases in group B took a change for the worse,and we made a comparison between the two groups(P< 0.001 ,P< 0.01 );(2)66 of 140 cases in group A had abnormal Bun,among which 24 cases were abnormity of admission.Two time course had 42 cases for abnormity;29 of 94 cases in group B had abnormal Bun,among which 19 cases were abnormity of admission, two time course had 10 cases for abnormity.and we made a comparison between the two groups(P< 0.001 ).Conclusion The side effect in treating SCH with high dosage mannitol related to the extension of intracerebral hematoma and the injury of kidney function (at the onset <6 h,6 h to 12 h).