甘露醇对自发性脑出血预后的不良影响(附525例前瞻性研究及352例回顾性分析)

目的　研究甘露醇对自发性脑出血 (SCH)预后的不良影响。方法　对 1990年以前用甘露醇常规大剂量 (2 5 0 m l)治疗 35 2例 SCH患者 (A组 )进行回顾性分析 ,并对 1991年以后用甘露醇小剂量 (12 5 m l)治疗 5 2 5例 SCH患者 (B组 )行前瞻性研究。结果　 (1)发病 <6小时、6～ 12小时内用药 ,A组 2 6 7例中 81例病情加重 ;B组 411例中 38例加重 ,两组比较 P <0 .0 0 1,P <0 .0 1;(2 )死亡病例 ,A组 140例中 6 6例血尿素氮 (Bun)异常 ,其中入院异常 2 4例 ,两个时程异常 42例 ;B组 94例中 2 9例 Bun异常 ,其中入院异常 19例 ,两个时程异常 10例 ,两组比较 P<0 .0 0 1。结论　大剂量甘露醇对 SCH的不良影响与其对发病 <6小时、6～ 12小时内 SCH患者脑内血肿进一步扩大及肾功能的损害有关。

The side effect on mannitol to the prognosis of spontaneous cerebral hemorrhage

Objective To study the side effect on mannitol to the prognosis of spontaneous cerebral hemorrhage (SCH).Methods 352 patients with SCH in group A given routine high dosage mannitol (250 ml) before 1990 were analysed retrospectively.525 patients with SCH in group B given little dosage mannitol (125 ml) after 1991 were analysed prospectively.Results (1)At the onset <6 h,6 h to 12 h,81 of 267 cases in group A took medicine and took a change for the worse;38 of 411 cases in group B took a change for the worse,and we made a comparison between the two groups(P< 0.001 ,P< 0.01 );(2)66 of 140 cases in group A had abnormal Bun,among which 24 cases were abnormity of admission.Two time course had 42 cases for abnormity;29 of 94 cases in group B had abnormal Bun,among which 19 cases were abnormity of admission, two time course had 10 cases for abnormity.and we made a comparison between the two groups(P< 0.001 ).Conclusion The side effect in treating SCH with high dosage mannitol related to the extension of intracerebral hematoma and the injury of kidney function (at the onset <6 h,6 h to 12 h).