目的：：观察两种剂量甘露醇治疗方案对中等量幕上脑出血的临床疗效和早期血肿扩大的影响。方法：将我院自2013年1月至2015年3月收治的发病时间在24 h内且血肿体积为15~30 mL的急性幕上脑出血患者随机分为两组：一组给予20%甘露醇250 mL,连续7 d,另一组给予20%甘露醇125 mL快速静脉滴注,连续7 d；采用发病后3月时的mRS评分作为临床疗效指标。 mRS评分为0~2分的定义为结局良好；治疗1 d后复查头颅CT,测量血肿体积,以血肿体积增大比入组时增大33%以上定义为早期血肿扩大。结果：共入选78例,两组各39例,采用250 mL甘露醇治疗组发病后3月时结局良好的有17例,占43.9%(17/39),采用125 mL甘露醇治疗组有26例,占66.7%(26/39),两组比较有显著统计学差异(P<0.01)；采用250 mL治疗组血肿扩大比率为17.9%(7/39),125 mL治疗组为7.7%(3/39),两组比较有显著统计学差异(P<0.01)。结论：对于中等量的幕上脑出血,125 mL甘露醇的临床疗效好于250 mL,且低剂量治疗对早期血肿扩大的影响较小,临床应扩大样本深入研究有利于其推广。%Objective:To observe the clinical effect of two doses of mannitol on supratentorial cerebral hemorrhage in moderate volume and the influence on early hematoma expansion. Methods:From January 2013 to March 2015,patients in our hospital having a-cute supratentorial intracerebral hemorrhage within 24 hours and hematoma volume within 15-30 mL were randomly divided into two groups. One group was treated with 20% mannitol 250 mL fast intravenous drip Q8h for 7 days,and the other group treated with 20%mannitol 125 mL fast intravenous drip Q8h for 7 days. The mRS score 3 months after onset was used as clinical curative effect index. mRS score 0 to 2 points is defined as a good outcome;one day after mannitol treatment,using brain CT to measure the volume of hema-toma,hematoma volume increasing more than 33% comparing that of before treatment is defined as early hematoma enlargement. Re-sults:A total of 78 cases were selected,each group 39 cases. In 250 mL mannitol group,17 cases had good outcome after 3 months treat-ment,accounting for 43. 9%(17/39),in 125 mL mannitol treatment group the cases with good outcome were 26(66. 7%,26/39),the difference had statistical significance(P<0. 01);The ratio of early hematoma enlargement in 250 mL mannitol treatment group was 17. 9%(7/39),125 mL treatment group 7. 7%(3/39),the difference had statistical significance(P<0. 01). Conclusion:For moderate supratentorial intracerebral hemorrhage,the clinical curative effect of 125 mL mannitol is better than that of 250 mL mannitol,and low dose treatment has little influence on early hematoma enlargement. The sample size for further study should be enlarged which will be beneficial for the popularization.
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