The Curative Effect Of Mannitol For Early Period Of Intracerebral Hemorrhage: A Systematic Review

Objective: To asses whether Mannitol can improve functional outcome without causing harm in patients with early period of intracerebral hemorrhage. In order to offer evidence-based for using mannitol in early period of intracerebral hemorrhage reasonably and regularly.Methods:According to the Cochrane reviewer's handbook,included studies were those on patients with histologically confirmed local advanced intertrochanteric fractures.The search strategy was developed according to the Collaborative Review Group search strategy.Medline,CBM,VIP,EMBASE,Cochrane library,articles in the academic degree collections were searched for clinic trails comparing efficacy of local advanced mannitol for early period of intracerebral hemorrhage of RCT would be assessed for quality according to the concealment of treatment allocation,blinding of patients and outcome assessors,adequate descriptions of numbers and teasons for patient withdrawl and graded their methodologic quality according to the method of Jadad.The Revman4.2 provided by the Cochrane collaboration was used to review management and analysis.The results were expressed as Relative Risk(RR)and 95% confidence internals(CI) for dischotomous outcomes.Data was pulled using fixed effect model or random effect model according to their homogeneity or heterogeneity.Chi-square tests for hetorogeneity would be performed and sensitivity analysis would be undertaken if considered appropriate.Results :First I identified 108 papers on mannitol in the treatment of early period of intracerebral hemorrhage. published from 1988-2008。8 trials involving 832 patients were identified as meeting all the hematoma enlargement rate, improvement in neurological deficit ,but no complication ,mortality, re-hospitalization rate events were reported. Five trials measured neurological deficit at the end of treatment. No severe adverse events were reported.8 trials,which included a total of 832 patients,provided detailed information on hematoma enlargement or improvement in neurological deficit rates over given mannitol in 6 hours or 24 hours of cerebral hemorrhage . I found the risk of hematoma enlargement given mannitol in first 6 hours appeared to be higher than that from given mannitol after 6 hours(Peto-OR=3.07,P=0.0003).And the risk of hematoma enlargement from given whole quantity mannitol in 24 hours appeared to be higher than that from given mannitol after 24 hours(Peto-OR=6.00,P=0.00001), .I also found an increase in the relative risk of hematoma enlargement between half quantity mannitol in 24 hours and given mannitol after 24 hours,but there was no significant difference between the two group(sPeto-OR=1.86,P=0.07). 4 trials included a total of 494 patients provided data on improvement in neurological deficit.The risk of improvement in neurological deficit rate from given half quantity mannitol in 24 hours to be lower than that from given half quantity mannitol after 24 hours(Peto-OR=0.50,P=0.01). I also found there was a significant difference in the relative risk of improvement in neurological deficit rate in given whole quantity mannitol in 24 hours between given whole quantity mannitol after 24 hours(Peto-OR=0.36,P<0.001)Conclusions:In comparison with mannitol in the treatment of early period of cerebral hemorrhage, given mannitol in 6 or 24 hours of cerebral hemorrhage increases the risk of hematoma enlargement tendency . given mannitol after 24 hours improve neurological deficit tendency compare with given mannitol in 24 hours.