Tan Ge, Zhou Ji-Ying, Mao Yuan-Chao, Liu Bo-Wen, Liao Qi
Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Zhonghua Yi Xue Za Zhi. 2008 Apr 1;88(13):889-91.
To explore the most effective daily dose and use method of mannitol in reducing intracranial pressure in patients with cerebral hemorrhage in acute stage.
One hundred and eighteen cerebral hemorrhage patients with elevated intracranial pressure, 74 males and 44 females, aged (58 +/- 11) (33-80), that had undergone cranial CT scanning to calculate the volume of hemorrhage, were divided into 4 groups treated with 20% mannitol 125 ml: 32 cases treated q 4 h, 35 cases treated q 6 h, 25 cases treated q 8 h, and 26 cases treated q 12 h. The everyday doses of mannitol were recorded. Intracranial pressure was monitored daily by NIP-200 noninvasive intracranial pressure apparatus. The difference between the very day and that of the last day (effect of decreasing intracranial pressure per day) was calculated. Multivariate regression analysis was conducted.
The average saturation dosage of mannitol was 750-6000 (3504 +/- 1085) ml, the time from the hospitalization till the saturation dosage was 1-8 (4.5 +/- 1.5) d. The average intracranial pressure at admission was 330-698 (486 +/- 93) mm H2O, the average intracranial pressure when mannitol reached the saturation dosage was 160-378 (253 +/- 52) mm H2O. The effect of reduction of intracranial pressure was not associated with age (P > 0.05). The effects of reducing intracranial pressure in the 1st, 2nd, 3rd, and 4th day were associated with the volume of hematoma and mannitol doses (all P < 0.01). Best effects of reducing the intracranial pressure in the 1st, 2nd, 3rd, and 4th day could be reached when 20% mannitol 125 ml was used every 4 hours.
Mannitol use every 4 hours per day has evident effect of reducing the intracranial pressure in the 1st, 2nd, 3rd, and 4th day, then mannitol should be used temporarily according to the intracranial pressure after the 5th day. Mannitol should not be used for more than 8 days.
探讨甘露醇降低急性期脑出血患者颅内压的最有效日剂量及使用方法。
118例颅内压升高的脑出血患者，男74例，女44例，年龄（58±11）（33 - 80）岁，均行头颅CT扫描计算出血量，分为4组，均用20%甘露醇125 ml治疗：每4小时治疗32例，每6小时治疗35例，每8小时治疗25例，每12小时治疗26例。记录甘露醇每日用量。每日用NIP - 200无创颅内压仪监测颅内压。计算当日与最后一日颅内压差值（每日降颅内压效果）。进行多因素回归分析。
甘露醇平均饱和用量为750 - 6000（3504±1085）ml，从住院至饱和用量时间为1 - 8（4.5±1.5）d。入院时平均颅内压为330 - 698（486±93）mmH₂O，甘露醇达饱和用量时平均颅内压为160 - 378（253±52）mmH₂O。降颅内压效果与年龄无关（P＞0.05）。第1、2、3、4日降颅内压效果与血肿量及甘露醇用量有关（均P＜0.01）。每4小时用20%甘露醇125 ml，第1、2、3、4日降颅内压效果最佳。
每日每4小时使用甘露醇，第1、2、3、4日降颅内压效果明显，第5日后应根据颅内压情况临时使用甘露醇。甘露醇使用不应超过8天。
