小剂量甘露醇治疗老年大面积脑梗塞的临床探讨

Clinical observation on low dosages of mannitol in the treatment of elderly patients with acute large area cerebral infarction

目的总结小剂量甘露醇在老年大面积脑梗塞治疗的临床经验。方法回顾性分析我院2010年10月至2014年1月54例经颅脑CT或MRI确诊的老年脑梗死患者,梗死面积>3 cm2,予小剂量甘露醇治疗,观察临床疗效,记录患者肝、肾功能及电解质变化结果,评估药物安全性。结果 54例中有1例患者死亡,死亡率1.58%;43例显效,总有效率81.48%;有1例患者在住院期间脑水肿加重,予加用利尿剂治疗后好转;有2例(3.70%)患者肾功能轻度异常,1例(1.85%)患者出现转氨酶轻度升高,经保肝、护肾治疗后好转;27例患者出现不同程度低钠,低钾,予相应治疗后好转。结论在老年大面积脑梗塞治疗中,小剂量甘露醇可获得满意的治疗效果,减少药物副作用,降低急性脑水肿发生,治疗有效性及安全性良好。

Objective To study the clinical experience of small doses of mannitol in the treatment of elderly patients with acute large area cerebral infarction. Methods Retrospectively analyze the datas of 54 elderly patients with cerebral infarction during October 2010 and January 2014 who were diagnosed by craniocerebral CT or MRI,and when the infarction area was greater than 3cm2,they were given low dose of mannitol. The clinical curative effect was observed,recorded the change of the patient＇s liver and kidney function and electrolyte,and evaluated its safety. Results Among the 54 cases,1 patient died,mortality rate was1. 58%. 43 cases obtained effective efficacy,total effective rate was 81. 48%. 1 case of cerebral edema aggravated during hospitalization,and the situation improved after diuretics treatment. 2 cases（ 3. 70%） with mild abnormal renal function,1 case（ 1. 85%） had mild elevation of aminotransferase,and they healed after liver and renal protecting treatment. 27 patients appeared different degree of low sodium,low potassium,and the situation improved after corresponding treatment. Conclusions Small dose of mannitol can obtain satisfactory curative effect,reduce the drug side effects and reduce the acute cerebral edema,it is effective and safe.