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目的探讨高血压性脑出血超早期使用速尿与甘露醇对血肿大小的影响及临床症状的变化情况,为高血压性脑出血超早期合理使用甘露醇提供依据。方法选择96例高血压性脑出血患者,根据血肿大小分为小量、中等量和大量脑出血3组,每组在发病6h内分别应用甘露醇或速尿,6、24h后复查头颅CT;30、90d时使用中国卒中评分(CSS)和日常生活能力评分(Barthel指数)来评定患者临床症状改善程度。结果 6、24h小、中量出血患者甘露醇组血肿扩大例数明显多于速尿组(P<0.05);30及90d后CSS评分表明使用速尿的中、小量出血组恢复明显好于甘露醇组(P<0.05);Barthel指数显示使用速尿的小量出血组90d后明显优于甘露醇组(P<0.05)。结论高血压性脑出血患者发病6h内不适当应用甘露醇可增加早期血肿扩大的发生率,对于颅压增高不突出的中、小量脑出血,尤其发病6h以内的超早期患者,不宜盲目使用甘露醇。
Objective To investigate the effects of furosemide and mannitol on the size of hematoma and the changes of clinical symptoms in patients with hypertensive intracerebral hemorrhage over a very early period and to provide a basis for rational use of mannitol in hypertensive intracerebral hemorrhage. Methods 96 patients with hypertensive intracerebral hemorrhage were divided into three groups according to the size of hematoma: small amount, medium dose and large amount of intracerebral hemorrhage. Mannitol or furosemide were respectively administered within 6 hours after onset. Head CT was reviewed 6 and 24 hours later. At 30 and 90 days, the assessment of clinical symptoms was assessed using the China Stroke Scale (CSS) and the Daily Living Ability Score (Barthel Index). Results The number of hematoma enlargement in mannitol group was significantly higher than that in furosemide group at 6 and 24 hours (P <0.05). The CSS scores at 30 and 90 days showed that the use of furosemide in moderate and small hemorrhage group was significantly better than that of furosemide group Mannitol group (P <0.05). The Barthel index showed that furosemide group was superior to mannitol group (P <0.05) after 90 days. Conclusion In patients with hypertensive intracerebral hemorrhage, the inappropriate use of mannitol during 6 hours can increase the incidence of early hematoma enlargement. It is not appropriate to blindly use moderate or small amount of intracerebral hemorrhage that is not prominent in intracranial pressure, especially in patients with ultra early stage within 6 hours of onset Mannitol.