早期使用甘露醇对颅内血肿的影响  

Influence of mannitol used in early stage of intracranial hematoma

作　　者：孙起军[1] 

机构地区：[1]首都医科大学密云教学医院密云县医院神经外科,北京市101500

出　　处：《中国基层医药》2012年第8期1139-1140,共2页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨早期应用甘露醇对颅内血肿的影响。方法回顾178例颅内血肿患者资料，根据治疗方法分为观察组（88例）和对照组（90例），两组患者入院后均行CT检查，给予一般治疗的基础上，观察组出血6h内给予甘露醇静脉滴注，对照组入院后不给予甘露醇。治疗后24h复查CT，随诊1个月以上。观察两组治疗前后血肿大小变化、GCS评分及1个月后生活质量。结果出血量观察组（27．6±5．7）ml，对照组（23．1±4．8）ml；观察组血肿增大患者所占比例（72．73％）明显大于对照组（P〈0．05）。GCS评分观察组（5．0±1．5）分，对照组（9．5±1．5）分，观察组明显低于对照组（P〈0．05）。治疗后1个月病死率观察组15．9l％（14／88），对照组7．78％（7／90），两组差异有统计学意义（P〈0．05）。中残疾以上患者发生率观察组69．32％（61／88），对照组40．00（36／90），观察组明显高于对照组（P〈0．05）。结论早期应用甘露醇可增加血肿增大率，明显增加患者病死率及致残率，建议颅内血肿早期患者避免使用甘露醇脱水治疗。Objective To study the influence of mannitol used in eraly stage of intracranial hematoma. Methods 178 cases diagnosed intracranial hematoma were divided into two groups according to the treatment. After admission, all patients were detected by CT. On the basis of the routine treatment, the treatment group（ 88 cases） were given mannitol within 6h after bleeding, while the control group were given nothing. To observe the change in hematoma size, GCS score and the quality of life 30d after treatment. Results The experiment group＇s average bleeding loss was （27. 6 ± 5.7 ） ml, while the control group＇s average bleeding loss was （23.1 ± 4.8） ml, the proportion of patient of treatment groups whose hematoma increased was significantly greater than the control group（ P 〈 0.05 ）. At the aspect of GCS score, the experiment group was （5.0 ± 1.5 ）, while the control group was （ 9.5 ± 1.5 ）, the average score of treatment group was significantly lower than the control group（P 〈0.05）. 30d after treatment,14 cases of experiment group dead, the mortality rate was 15.91% ,while the control group＇s motality rate was 7.78%. The mortality rate of treatment group was significantly higher than the control group（P 〈 0.05）. Conclusion Mannitol used in early stage of intracranial hematoma promotes the growth of intracranial hematoma and increases the mortality. The patients with intracranial hematoma should avoid the use of manntol in early stage.

关 键 词：脑出血 甘露醇 早期阶段 

分 类 号：R651.15[医药卫生—外科学]