【摘要】 目的观察早期高血压性脑出血患者甘露醇治疗前后颅内血肿的大小,经颅多普勒血流动力学参数,以及血浆内皮素-1水平的变化,对如何正确使用甘露醇作初步探讨。方法160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,头颅CT测定血肿大小、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 index,PI),使用放免法测定血浆内皮素-1水平,对实验前后上述参数的变化进行统计学分析。结果治疗前2组患者血肿大小、Vm和PI值以及血浆内皮素-1水平比较,P>0.05,差异无统计学意义;而治疗后甘露醇治疗组血肿大小、Vm值及PI值分别较该组患者治疗前增加、减小、增加;非甘露醇治疗组上述值则分别较治疗前减小、增加、减小,治疗前后比较,P均<0.05,差异有统计学意义。结论血浆内皮素-1水平对判断高血压性脑出血患者的预后有一定的参考意义,早期发病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,TCD血流动力学参数对脱水治疗有指导意义。更多还原

【Abstract】 Objective To investigate the changes of hematoma sizes,TCD hemodynamics parametes,plasma endothelin-1 in prior treatment and post-treatment patients,and to discuss initially how to use mannitol correctly.Methods One hundred and sixty cerebral hemorrhage patients caused by hypertension were grouped randomly mannitol-treated group and non-mannitol-treated group. Hematoma size,Vms and PIs of medium-sized artery were measured by head-CT and TCD respectively,and plasma endothelin-1 was evaluated with radioimmunity technique. All data of pre-treated and post-treated were analyzed statistically.Results The difference of hematoma sizes,Vms,PIs and plasma endothelin-1 was not significant between prior treatment and post-treatment patients (P>0.05). After treatment,hematoma sizes was increased,Vms was diminished and PIs was increased compared with prior treatment in the mannitol-treated group. But all the data were opposite in the non-mannitol-treated group.The difference was significant(P<0.05)compared the mannitol-treated group and the non-mannitol-treated group.Conclusion The plasma endothelin-1 was valuable to judge the prognosis of cerebral hemorrhage patients because of hypertension,and small hematoma patiens should be very cautious treated with mannitol to avoid hematoma larger. TCD hemodynamics parametes were guidance to cerebral hemorrhage patients with mannitol.更多还原