不同时期高血压性脑出血病人脱水治疗后颅内血肿的变化

目的观察甘露醇对早期高血压性脑出血病人血肿大小以及血流动力学参数的影响,并探讨甘露醇的用药指证.方法 40例高血压性脑出血病人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.结果治疗前高血压性脑出血病人头颅CT测量血肿量以及使用TCD测定Vm及PI值两组无统计学意义(P>0.05);治疗后CT显示实验组血肿量增加,而对照组有所减小,两者比较有统计学意义(P<0.05);Vm值、PI值两组比较有统计学意义(P<0.05).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病人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 Hematoma of Cerebral Hemorrhage Caused by Hypertension Treatment with Dehydration in Different Periods

Objective To investigate the effect of mannitol on hematom size and hemodynamic parameters of cerebral hemorrhage in patiens with hypertension, explore corectly imply mannitol in clinical conditions.Methods 40 cerebral hemorrhage patiens caused by hypertension were divided into 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-treatted and post-treatted was analyzed statistically.Results The difference of hematom size and Vm and PI of middle cerebral artery between pre-treated was not significant between two groups(P>0.05).After treatment,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.Conclusions Mannitol should be cautiously used in cerebral hemorrhage patiens with hypertension to avoid hematoma enlargement.TCD hemodynamic paramete may be used to guide mannitol application in such patients.