不同剂量甘露醇治疗高血压性脑出血患者降颅压效果的临床研究

Clinical Study on the Effect of Different Doses of Mannitol in the Treatment of Hypertensive Cerebral Hemorrhage

目的研究不同剂量甘露醇治疗高血压性脑出血患者降颅压临床效果。方法选取2020年3月-2021年8月我院治疗的90例高血压性脑出血患者为研究对象,采用随机数字表法分为A组、B组、C组,各30例。A组采用甘油氯化钠及神经细胞营养药物对症治疗,B组、C组在A组基础上分别采用20%甘露醇250 ml、125 ml静脉输注治疗。比较三组临床治疗效果、出血量、血肿体积、神经功能缺损(NIHSS)评分、日常生活能力(ADL)分级情况以及临床不良反应发生情况。结果B组、C组治疗总有效率高于A组(P<0.05);而C组与B组治疗总有效率比较,差异无统计学意义(P>0.05)。B组、C组出血量小于A组(P<0.05),而C组与B组出血量比较,差异无统计学意义(P>0.05);B组、C组血肿体积小于A组,且C组小于B组(P<0.05)。B组、C组NIHSS评分低于A组(P<0.05),而C组与B组NIHSS评分比较,差异无统计学意义(P>0.05)。C组、B组ADLⅠ~Ⅲ级占比高于A组,Ⅳ~Ⅴ级占比低于A组,且C组Ⅰ~Ⅲ级占比高于B组,Ⅳ~Ⅴ级占比低于B组(P<0.05)。在治疗和观察期间,C组不良反应发生率低于B组、A组(P<0.05)。结论不同剂量甘露醇治疗高血压性脑出血均可获得相同的降颅压效果,但是与250 ml甘露醇比较,125 ml甘露醇可有效提高患者日常生活能力分级,减小血肿,降低不良反应发生率。

Objective To study the clinical effect of different doses of mannitol in the treatment of hypertensive cerebral hemorrhage.Methods A total of 90 patients with hypertensive cerebral hemorrhage treated in our hospital from March 2020 to August 2021 were selected as the research subjects.They were divided into group A,group B and group C by random number table method,with 30 cases in each group.Group A was treated with glycerin sodium chloride and neurotrophic drugs,and group B and group C were treated with 20%mannitol 250 ml and 125 ml intravenous infusion on the basis of group A.The clinical therapeutic effect,bleeding volume,hematoma volume,neurological deficit(NIHSS)score,daily living ability(ADL)classification and clinical adverse reactions were compared among the three groups.Results The total effective rate of group B and group C was higher than that of group A(P<0.05);while there was no significant difference in the total effective rate between group C and group B(P>0.05).The amount of bleeding in group B and group C was less than that in group A(P<0.05);while there was no significant difference in the amount of bleeding between group C and group B(P>0.05);the hematoma volume of group B and group C was smaller than that of group A,and that of group C was smaller than that of group B(P<0.05).NIHSS scores of group B and group C were lower than those of group A(P<0.05);while there was no significant difference in the NIHSS scores between group C and group B(P>0.05).The proportion of ADLⅠ-Ⅲin group C and group B was higher than that in group A,and the proportion of ADLⅣ-Ⅴwas lower than that in group A,and the proportion of ADLⅠ-Ⅲin group C was higher than that in group B,and the proportion of ADLⅣ-Ⅴwas lower than that in group B(P<0.05).During treatment and observation,the incidence of adverse reactions in group C was lower than that in group B and group A(P<0.05).Conclusion Different doses of mannitol have the same effect on reducing intracranial pressure in the treatment of hypertensive cerebral hemorrhage.However,compared with 250 ml of mannitol,125 ml of mannitol can effectively improve the classification of daily living ability,reduce hematoma and reduce the incidence of adverse reactions.