高血压性脑出血患者脱水治疗前后颅内血肿的变化

目的 观察甘露醇对早期高血压性脑出血患者血肿大小以及血流动力学参数的影响,并对如何正确使用甘露醇初步探讨。方法 40例高血压性脑出血患者随机分为甘露醇治疗组和非甘露醇治疗组,使用头颅CT测量血肿大小以及经颅多普勒(transcranial Doppler,TCD)测定大脑中动脉平均血流速度(blood flow mean velocity,Vm)及脉动指数(Pulse Indexes,PI),对实验前后参数的变化进行统计学分析。结果 在治疗前高血压性脑出血患者头颅CT测量血肿量以及使用TCD测定Vm及PI值,P>0.05,差异无显著性;而治疗后CT显示实验组血肿量增加,而对照组有所减小,二者比较P<0.05;Vm值显示实验组减小,而对照组增加,二者比较P<0.05;PI值显示实验组增加,而对照组减小,二者比较P<0.05,以上均提示差异有显著性意义。结论 对早期发病的颅内压增高症状不明显的少量高血压脑出血患者慎用甘露醇脱水治疗,以免血肿扩大,加重病情,TCD血流动力学参数对脱水治疗有指导意义。

Changes of intercranial hematom of cerebral hemorrhage patients caused by hypertension post - treatment with dehydration in different periods

Objective To investigate the effect of hematom sizes and hemodynamics parametes of cerebral hemorrhage patients caused by hypertension, using mannitol or not, and to discuss initially how to use mannitol correctly.Methods 40 cerebral hemorrhage patients caused by hypertension were grouped mannitol - treated group and non mannitol - treated group randomly. Hematom size and Vm and PI of medium - sized artery were measured using head - CT and TCD respectively, and data of pre - treated and post - treated was analyzed statistically. Results The difference of hematom size and Vm and PI of midle cerebral artery between pre - treated was not significant in two groups (P > 0.05) . After treated, hematom size estimated by CT was larger in mannitol - treated group, while the size was smaller in non mannitol - treated .group. The number of Vm was smaller in mannitol - treated group, but bigger in non mannitol - treated group.The number of PI was converse compared to the number of Vm.The difference was significant ( P < 0.05) in mannitol - treated group. Conclusion The cerebral hemorrhage patients becaused of hypertension should be very cautious if used mannitol to avoid hematoma larger and state of an illness worse.TCD hemodynamics parametes were guidance to cerebral hemorrhage patients with mannitol.