甘露醇治疗围产期缺氧缺血性脑损伤的研究

A randomized controlled trial of mannitol therapy in hypoxic-ischemic brain damage in newborn piglets

目的 探讨不同剂量甘露醇减轻脑水肿程度及对神经病理影响。方法 40只新生猪随机分为正常对照组、缺氧缺血性脑损伤模型组 (HIBD组 )、小剂量 (0 .5 g.kg- 1 )和大剂量 (2 g.kg- 1 )治疗组。四组均测颅内压 (ICP)、脑含水量(BTWC)、血浆渗透压及病理检查。结果 HIBD组 BTWC及 ICP较正常组明显增高 (P<0 .0 1)。两治疗组各时相点 ICP及 BTWC明显低于 HIBD组 ,且两治疗组 ICP及 BTWC下降程度无显著性差异 (P>0 .0 5 ) ,但大剂量组血浆渗透压较小剂量组明显增高 ,峰值达高渗状态 (P<0 .0 1)。结论 甘露醇能减轻脑水肿 ,但对神经细胞不可逆改变无治疗作用。小剂量安全而有效 ,用药时间 3～ 4小时为宜。监测血浆渗透压及

Objective To evaluate the efficacy of mannitol in reducing cerebral edema and improving the neuropathologic outcome in perinatal cerebral hypoxia-ischemia in newborn pegletsMethods Forth newborn piglets were divided into four groups:normal group,hypoxic-ischemic brain damage(HIBD) model group,low-dose mannitol treatment group(05g·kg -1) and high-dose mannitol treatment group(2g·kg -1).Effects on intracranial pressure(ICP)reduction and changes of serum osmolality and electrolyte were observed.After 6 hours of recovery from hypoxia-ischemia,the animals were killed and their brains were examined for brain tissue water content(BTWC)and the paathologic alterations.Results ICPand BTWC in HIBD model group were significantly higher than that in normal group(P<0.05).Mannitol therapy reduced ICP and BTWC in the two mannitol treatment groups.The extent of decreased ICP and BTWC was not proportionate to the mannitol dose administered.Serum osmolality significantly increased and the dose-response characteristics of mannitol usage were presented following the two doses of mannitol administration.Conclusion Mannitol therapy reduces cerebral edema,low-dose mannitol is safer than high-dose in the treatment of HIBD,and it is appropriate to use mannitol at 3～4hours,intervals.