Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, China.
J Clin Pharm Ther. 2021 Apr;46(2):504-514. doi: 10.1111/jcpt.13314. Epub 2020 Nov 20.
Glycerol is thought to be superior to mannitol in the treatment of cerebral oedema and elevated intracranial pressure (ICP), particularly with safety concerns. However, the current evidence remains insufficient. Therefore, we aimed to compare the efficacy and safety of glycerol versus mannitol in this meta-analysis.
PubMed, EMBASE, Web of Science, CENTRAL, China National Knowledge Infrastructure, Wanfang Database, Chongqing VIP information, ClinicalTrials.gov, and the reference lists of relevant articles were searched for randomized controlled trials comparing glycerol and mannitol in patients with brain oedema and elevated ICP. Two investigators independently identified the articles, assessed the study quality and extracted data. Data analyses were performed using RevMan software.
Thirty trials involving 3144 patients met our inclusion criteria. Pooled data indicated that glycerol and mannitol had comparable effectiveness in controlling cerebral oedema (RR, 1.00; 95% CI, 0.97 to 1.03; p = .97), but the risks of acute kidney injury and electrolyte disturbances were significantly lower with glycerol (RR, 0.21; 95% CI, 0.16 to 0.27 and RR, 0.23; 95% CI, 0.17 to 0.30, respectively) than mannitol. Moreover, there seemed to be a lower probability of rebound ICP after the withdrawal of glycerol. Neither haemolysis nor elevated blood glucose levels were observed in the glycerol group.
Regarding the balance between efficacy and safety, glycerol could be an effective and more tolerable alternative therapy for cerebral oedema and elevated ICP than mannitol, especially for high-risk populations of renal failure.
甘油在治疗脑水肿和颅内压升高（ICP）方面被认为优于甘露醇，尤其是在安全性方面。然而，目前的证据仍然不足。因此，我们旨在通过这项荟萃分析比较甘油与甘露醇在治疗中的疗效和安全性。
我们检索了 PubMed、EMBASE、Web of Science、CENTRAL、中国知网、万方数据库、重庆维普信息、ClinicalTrials.gov 以及相关文章的参考文献，以寻找比较甘油和甘露醇治疗脑水肿和 ICP 升高的随机对照试验。两名调查员独立确定文章、评估研究质量并提取数据。数据分析使用 RevMan 软件进行。
共有 30 项试验涉及 3144 名患者符合我们的纳入标准。汇总数据表明，甘油和甘露醇在控制脑水肿方面的疗效相当（RR，1.00；95%CI，0.97 至 1.03；p=0.97），但甘油治疗引起急性肾损伤和电解质紊乱的风险显著低于甘露醇（RR，0.21；95%CI，0.16 至 0.27 和 RR，0.23；95%CI，0.17 至 0.30）。此外，与甘露醇相比，撤去甘油后颅内压反弹的可能性似乎较低。甘油组未观察到溶血或血糖水平升高。
就疗效和安全性的平衡而言，甘油可能是脑水肿和 ICP 升高的一种有效且更耐受的替代治疗方法，尤其是对肾衰竭高危人群。
