甘露醇对高血压性脑出血患者早期血肿扩大的影响

Influence of mannitol on early enlargement of hematoma in hypertensive cerebral hemorrhage

目的 探讨甘露醇对高血压性脑出血早期血肿扩大的影响及如何正确使用甘露醇。方法 选择 93例高血压性幕上性非丘脑脑出血、脑压增高不突出、发病 6h内脑CT血肿 <30ml的患者 ,分为 2 4h内应用甘露醇组 (4 6例 )和不用甘露醇组 (4 7例 ) ;48h复查脑CT ,血肿增大超过 33%为早期血肿扩大 ,分析发病 2 4h内应用甘露醇对早期血肿扩大的影响。结果 发病 2 4h内使用甘露醇组发生早期血肿扩大 14例 (14/ 46 ) ,未用甘露醇组 4例 (4 / 47) ,两者比较差异有非常显著意义 (P <0 .0 1) ;首次CT时 2组神经功能缺损积分比较差异无显著意义 (P >0 .0 5 ) ,2 4h内使用甘露醇组复查CT时神经功能缺损积分明显高于未用甘露醇组 (P <0 .0 5 ) ;前者死亡 5例 ,后者死亡 1例。结论 高血压性脑出血患者发病 2 4h内不适当应用甘露醇可增加早期血肿扩大的发生率 ,使病情加重。对于脑压增高不突出 ,尤其发病 2 4h内的高血压性脑出血患者 ,不宜盲目使用甘露醇 ,以免使血肿扩大 ,加重病情。

Objective To probe into the influence of mannitol on early enlargement of hematoma in hypertensive cerebral hemorrhage, and to discuss how to use mannitol correctly. Methods 93 patients with hypertensive supratentorial non thalamic cerebral hemorrhage and light intracranial hypertension, and with less than 30 ml of hematoma volume determined by cranial CT within 6 h after the onset were randomly divided into a group in which mannitol was used ( n =46) or a group in which mannitol was not used ( n =47) within 24 h. Cranial CT was redone at 48 h. If the volume of hematoma increased by 33%, it was named early enlargement of hematoma. The influence of using mannitol within 24 h after the onset on early enlargement of hematoma was analyzed. Results 14(14/46) patients in the group in which mannitol was used within 24 h after the onset had early enlargement of hematoma, yet 4(4/47) patients in the group without mannitol had hematoma enlargement. There was significant difference between them ( P <0.01). No significant difference was seen between the integral of nerve function defect in the two groups when CT was done at the first time ( P >0.05). When CT was redone, the integral of nerve function defect in the group with mannitol used within 24 h was markedly higher than that in the group without mannitol ( P <0.05). 5(5/46) patients died in the former group and 1(1/47) in the latter. Conclusion Improper use of mannitol within 24 h after the onset may increase the incidence of early enlargement of hematoma in patients with hypertensive cerebral hemorrhage, and exacerbate the patient's condition. For patients with hypertensive cerebral hemorrhage with light intracranial hypertension, especialy those within 24 h after the onset, mannitol should not be used blindly, in case that it enlarges the hematoma and exacerbates patient's condition.