Shi Y, Kong X
Department of Neurology, Tengzhou Central People's Hospital, Tengzhou 277500, China.
Zhonghua Yi Xue Za Zhi. 2000 Nov;80(11):849-51.
To probe into the influence of mannitol on early enlargement of hematoma in hypertensive cerebral hemorrhage, and to discuss how to use mannitol correctly.
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.
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.
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.
探讨甘露醇对高血压性脑出血早期血肿扩大的影响，以及讨论如何正确使用甘露醇。
93例高血压幕上非丘脑脑出血且颅内压轻度升高、发病6小时内头颅CT显示血肿体积小于30ml的患者，随机分为24小时内使用甘露醇组（n = 46）和不使用甘露醇组（n = 47）。48小时时复查头颅CT。若血肿体积增加33%，则称为血肿早期扩大。分析发病后24小时内使用甘露醇对血肿早期扩大的影响。
发病后24小时内使用甘露醇组有14（14/46）例患者出现血肿早期扩大，而未使用甘露醇组有4（4/47）例患者出现血肿扩大。两组间差异有统计学意义（P < 0.01）。首次CT检查时两组神经功能缺损积分差异无统计学意义（P > 0.05）。复查CT时，发病后24小时内使用甘露醇组的神经功能缺损积分明显高于未使用甘露醇组（P < 0.05）。前一组有5（5/46）例患者死亡，后一组有1（1/47）例患者死亡。
发病后24小时内不当使用甘露醇可能增加高血压性脑出血患者血肿早期扩大的发生率，并加重患者病情。对于颅内压轻度升高的高血压性脑出血患者，尤其是发病24小时内的患者，不应盲目使用甘露醇，以免扩大血肿并加重患者病情。
