Marshall L F, SMith R W, Rauscher L A, Shapiro H M
J Neurosurg. 1978 Feb;48(2):169-72. doi: 10.3171/jns.1978.48.2.0169.
There is little information as to the optimal use of mannitol. To determine the dose-response relationship, the osmotic gradient required, and the time course of intracranial pressure (ICP) reduction produced by mannitol, eight patients with acute head injury were studied in whom ICP was monitored with a ventriculostomy and found to be elevated. Ventilation was controlled to a pCO2 of 25 +/- 3 mm Hg and all were paralyzed with Pavulon. None had received barbiturates. Before mannitol administration the intracranial volume-pressure response was determined. Mannitol was administered as a bolus of 0.25 gm/kg, 0.5 gm/kg, and in six patients, 1 gm/kg, separated by at least 8 hours. In all patients the ICP reduction with 0.25 gm/kg (41.3 +/- 10.2 mm Hg leads to 16.4 +/- 5.6, p less than 0.01) was equivalent to that achieved with the larger doses. Serum osmolality rises of 10 mOsm or more were associated with a reduction in ICP. Much smaller doses than those previously recommended were effective in reducing the ICP acutely, although at 5 hours there was a trend toward persistent reduction when the larger dose is used. This trend was small and indicates that smaller and more frequent doses are as effective in reducing the ICP while avoiding the risk of osmotic disequilibrium and severe dehydration.
关于甘露醇的最佳使用方法，目前几乎没有相关信息。为了确定剂量-反应关系、所需的渗透梯度以及甘露醇降低颅内压（ICP）的时间过程，对8例急性颅脑损伤患者进行了研究，这些患者通过脑室造瘘术监测颅内压，发现颅内压升高。将通气控制在动脉血二氧化碳分压（pCO2）为25±3mmHg，所有患者均使用泮库溴铵使其麻痹。均未接受过巴比妥类药物治疗。在给予甘露醇之前，先测定颅内容量-压力反应。甘露醇以0.25g/kg、0.5g/kg的推注剂量给药，6例患者给予1g/kg的推注剂量，给药间隔至少8小时。在所有患者中，0.25g/kg剂量导致的颅内压降低（从41.3±10.2mmHg降至16.4±5.6mmHg，p<0.01）与较大剂量导致的颅内压降低效果相当。血清渗透压升高10mOsm或更多与颅内压降低相关。虽然在5小时时，使用较大剂量有持续降低颅内压的趋势，但急性降低颅内压所需的剂量比先前推荐的剂量小得多。这种趋势并不明显，表明较小且更频繁的剂量在降低颅内压方面同样有效，同时可避免渗透失衡和严重脱水的风险。
