Wakai Abel, McCabe Aileen, Roberts Ian, Schierhout Gillian
Emergency Care Research Unit (ECRU), Division of Population Health Sciences (PHS), Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
Cochrane Database Syst Rev. 2013 Aug 5;2013(8):CD001049. doi: 10.1002/14651858.CD001049.pub5.
Mannitol is sometimes effective in reversing acute brain swelling, but its effectiveness in the ongoing management of severe head injury remains unclear. There is evidence that, in prolonged dosage, mannitol may pass from the blood into the brain, where it might cause increased intracranial pressure.
To assess the effects of different mannitol therapy regimens, of mannitol compared to other intracranial pressure (ICP) lowering agents, and to quantify the effectiveness of mannitol administration given at other stages following acute traumatic brain injury.
We searched the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE (OvidSP), EMBASE (OvidSP), ISI Web of Science (SCI-EXPANDED & CPCI-S) and PubMed. We checked reference lists of trials and review articles, and contacted authors of trials. The search was updated on the 20th April 2009.
Randomised controlled trials of mannitol, in patients with acute traumatic brain injury of any severity. The comparison group could be placebo-controlled, no drug, different dose, or different drug. We excluded cross-over trials, and trials where the intervention was started more than eight weeks after injury.
We independently rated quality of allocation concealment and extracted the data. Relative risks (RR) and 95% confidence intervals (CI) were calculated for each trial on an intention to treat basis.
We identified four eligible randomised controlled trials. One trial compared ICP-directed therapy to 'standard care' (RR for death = 0.83; 95% CI 0.47 to 1.46). One trial compared mannitol to pentobarbital (RR for death = 0.85; 95% CI 0.52 to 1.38). One trial compared mannitol to hypertonic saline (RR for death = 1.25; 95% CI 0.47 to 3.33). One trial tested the effectiveness of pre-hospital administration of mannitol against placebo (RR for death = 1.75; 95% CI 0.48 to 6.38).
AUTHORS' CONCLUSIONS: Mannitol therapy for raised ICP may have a beneficial effect on mortality when compared to pentobarbital treatment, but may have a detrimental effect on mortality when compared to hypertonic saline. ICP-directed treatment shows a small beneficial effect compared to treatment directed by neurological signs and physiological indicators. There are insufficient data on the effectiveness of pre-hospital administration of mannitol.
甘露醇有时对逆转急性脑肿胀有效，但其在严重头部损伤持续治疗中的有效性仍不明确。有证据表明，长期使用甘露醇时，它可能从血液进入大脑，进而可能导致颅内压升高。
评估不同甘露醇治疗方案的效果、甘露醇与其他降低颅内压（ICP）药物的比较效果，并量化急性创伤性脑损伤后其他阶段给予甘露醇的有效性。
我们检索了Cochrane损伤组专业注册库、CENTRAL（Cochrane图书馆）、MEDLINE（OvidSP）、EMBASE（OvidSP）、ISI科学网（SCI-EXPANDED & CPCI-S）和PubMed。我们检查了试验和综述文章的参考文献列表，并联系了试验的作者。检索于2009年4月20日更新。
对任何严重程度的急性创伤性脑损伤患者进行的甘露醇随机对照试验。对照组可以是安慰剂对照、无药物、不同剂量或不同药物。我们排除了交叉试验，以及干预在受伤后超过八周开始的试验。
我们独立评估分配隐藏的质量并提取数据。每个试验在意向性分析的基础上计算相对风险（RR）和95%置信区间（CI）。
我们确定了四项符合条件的随机对照试验。一项试验将ICP导向治疗与“标准护理”进行比较（死亡RR = 0.83；95% CI 0.47至1.46）。一项试验将甘露醇与戊巴比妥进行比较（死亡RR = 0.85；95% CI 0.52至1.38）。一项试验将甘露醇与高渗盐水进行比较（死亡RR = 1.25；95% CI 0.47至3.33）。一项试验测试了院前给予甘露醇与安慰剂相比的有效性（死亡RR = 1.75；95% CI从0.48至6.38）。
与戊巴比妥治疗相比，甘露醇治疗ICP升高可能对死亡率有有益影响，但与高渗盐水相比可能对死亡率有不利影响。与根据神经体征和生理指标进行的治疗相比，ICP导向治疗显示出较小的有益效果。关于院前给予甘露醇的有效性的数据不足。
