不同剂量甘露醇对高血压性脑出血血肿及脑血流动力学的影响

Influence of different dosage mannitol on the hematoma and hemodynamics after hypertensive intracerebral hemorrhage

目的观察不同剂量甘露醇对高血压性脑出血(HIH)患者血肿、血肿周围水肿、脑血流动力学和临床疗效的影响。方法80例HIH患者随机分为A组、B组和对照组(C),在给予脑出血常规治疗的同时,A组加用20%甘露醇250ml静脉输注,3～4次/d,持续14～21d。B组加用20%甘露醇125ml静脉输注2～3次/d,持续3～14d。检测血肿、血肿周围水肿体积,病灶侧大脑中动脉平均Vm和PI,神经功能缺损评分和肾功能异常情况。结果3组在治疗后7、21dA组血肿周围水肿体积与C组比较有显著性差异(P<0.05),A组与B组及B组与C组比较无显著性差异(P>0.05),治疗后21d3组间血肿体积均有显著性差异(P<0.05,P<0.01),B两组与C组神经功能缺损评分的分值有显著性差异(P<0.01),但A组与B组无显著性差异(P>0.05)。治疗后第21dA、B两组与C组Vm比较有显著性差异(P<0.01)。治疗后第21dA组出现肾功能异常9例,B组2例,C组3例,3组比较有显著性差异(P<0.05)。结论甘露醇能促进HIH患者血肿周围水肿的消退,有利于血肿区Vm的恢复,改善神经功能,但不同剂量甘露醇对HIH患者的血肿大小、神经功能缺损、脉动指数无影响,大剂量甘露醇对肾脏损害明显。

Objective To observe the influence of different dosage mannitol on the hematoma,peri-hematomal edema and hemodynamics after hypertensive intracerebeal hemorrhage(HIH)and its therapeutic efficacy.Methods The80cases of HIH were divided into3groups radom.Performing routine treatment ,also20%mannitol(250ml)was used3-4次/d for14-21d in group A,20%mannitol(125ml)was used2-3次/d for3-14d in group B.The volumes of hematoma and perihematomal edema were measured by CT,the mean blood flow velocity and pulsatility index(PI)were measured by TCD,and the neurological deficiency score(NDS),abnormity of kidney function were assessed separately.Result s There were no significant differences in the volumes of hematoma among3groups at the7th,21th day after treatment (P>0.05).There were significant differences in the volumes of peri-hematomal edema between group A and group C at the7th day after treatment (P<0.05),among the three groups at the21th day after treatment (P<0.05,P<0.01).There were significant differences in the NDS among group A,group B and group C at the21th day after treatment (P<0.01).There were significant differences in the Vm group A,B and the C at the21th day after treatment (P<0.01).9cases in group A,2cases in group B and3cases in group C with abnormity of kidney function at the21th day after treatment (P<0.05).Conclusion Mannitol can reduce the peri-hematomal edema,improve Vm and NDS of the patients with HIH.There is no much diffrence between the influences of large and small dosage of mannitol on the volumes of hematoma,NDS and PI of the patients with HIH.There is marked injury of kidney function using high dosage of mannitol.