Clinical Observation Of Mannitol In Cerebral Hemorrhage

Objective: Intracerebral hemorrhage is one of the neurological critical illness, mannitol as the preferred dehydrating agent was widely used in the treatment of cerebral hemorrhage. This study aimed to explore in depth the use of mannitol, to further guide the clinical work.Methods: We selected 313 patients with ICH admitted in our hospital from October 2006 to December 2007, All patients were given conservative medical treatment. The first CT was performed at admission and some patients whose condition aggravated review CT. Recorded renal function, routine urine, blood plasma, changes in the state of consciousness, the use of mannitol and the prognosis score. Using comparative analysis, discussed the use of mannitol in the treatment of cerebral hemorrhage, including targets, timing, frequency, treatment and suspended methods.Results:1. Patients with hemorrhage of <15ml, there were no significant differences in prognosis between no use of mannitol and using mannitol (P>0.05). Using mannitol group was more abnormal in renal function,urine routine, blood plasma obviously than those not using mannitol, the difference was significant (P<0.05). Patients with hemorrhage of 15-30 ml,there were no significant differences in prognosis between no use of mannitol and using mannitol (P>0.05). Using mannitol group was more abnormal in urine routine and blood plasma than those not using mannitol, the difference was significant (P<0.05).2. The ratio of hematoma expansion of using mannitol within 6h of the onset was significantly higher than after 6h (P<0.05); The prognosis of hematoma expand was significantly worse than hematoma no change (P<0.01).3. In the period between the use of mannitol, clinical symptoms as headache, nausea, vomiting, disturbance of consciousness or papillary edema was significantly less in using mannitol 4th a day group than in the 3rd a day and twice a day group (P<0.01).4. About the patients with the amount of bleeding between 15-30ml associated with the disturbance of consciousness, the changing of consciousness between using mannitol≤10 days group and >10 days group had no significant difference (P>0.05); But renal function and urine routine of >10 days group were more abnormal than≤10 days group obviously, the difference was significant (P<0.05). About the patients with the amount of bleeding more than 30ml,the changing of consciousness between using mannitol≤15 days group was significantly worse than >15 days group (P<0.05); and renal function and urine routine of >15 days group were more abnormal, the difference was significant (P<0.05).5. The changing of consciousness between Mannitol out all at once group and gradually stopping group had no significant difference (P>0.05); But renal function, urine routine and blood plasma of gradually stopping group were more abnormal, the difference was significant (P<0.05).Conclusion:1. Supratentorial cerebral hemorrhage with bleeding volume less than 15 ml could not be used mannitol, a small amount of thalamic hemorr-hage patients even if there was obstacles awareness could not be used mannitol.2. Patients whose bleeding volume between 15-30 ml without conscious barriers did not advocate the indiscriminate using of mannitol.3. Patients whose bleeding volume more than 30 ml should be used mannitol as a preferred therapy tool.4. Without life-threatening, we couldn't blindly use mannitol within six hours of onset.5. Using Mannitol four times daily was suitable.6. The timing of Mannitol should be as short as possible. Bleeding of less than 30 ml of not more than 10 days, more than 30 ml of not more than 15 days.7. Mannitol should be out all at once.