| Objective the intracranial hypertension is a commom pathology symptom complex in neurosurgery. the persistent ICH could couse a series of central neurological function disorder and pathological change. for this reason ,the exactly treatment of ICH is most importment for increase patient's prognosis. There are two methods to decrease intracranial pressure. One is reduction intracranial content, the other is expansion cranial capacity. In the past, mannitol is a major choice for decrease ICH. But there are many faults in applying mannitol to decrease ICH. We studied the effective and side effect of different dosage of mannitol to find reasonable dosage of mannitol. Method All patients were randomly signed three groups. Then each group received 0.5g/Kg.weight mannitol(27cases),1.0g/Kg.weight mannitol(25cases), 0.5g/Kg.weight mannitol + 20mg furosemide respectively(26 cases). ICP was continuously monitored before and during the protocol especially recorded before administration of different treatment and at the30 minute,the 60 minute and every one hour after administration of different treatment. Plasma osmolarity was monitored before and at the 45 mintue after administration of different dosage of mannitol. Blood- electrolytes, renal function, plasma osmolarity were monitored at hospitalization and every morning(on an empty stomach). Rusult (1) The changes of ICP. the effective power of the first group is 76.25%, the rebound ratio is 9.19%, the average amplitude of decreasing ICP is 24.58±2.27%, the average effective time is 197.7±13.6 mintues; the effective power of the second group is 77.87%, the rebound ratio is 8.51%, the average amplitude of decreasing ICP is 26.46±2.41%, the average effective time is 257.4±14.5 mintues; the effective power of the third group is 85.86%, the rebound ratio is 2.89%, the average amplitude of decreasing ICP is 25.12±2.53%, the average effective time is 292.8±14.7 mintues. The two thrapy group with mannitol have the similar ICP changes. ICP is decreased at 15 mintue after using mannitol. ICP at 30-60 mintue after mannitol are the lowest and3-4 hours after mannitol ,ICP have progressly got higher even higher than before mannitol. The ICP was gradually decreasd at 15 mintue after administration in the thrapy group with mannitol and furosemide, ICP at approximately 1-2 hours after administration are the lowest and about 5 hours after administration , ICP have progressly got higher even higher than before mannitol. The rebound of ICP existed in 5 cases with widespread contusion and laceration of brain and 8 cases with Postop intracranial hemorrhage(ICP>40mmHg).(2) The changes of Plasma osmolarity. Plasma osmolarity have got higher little by little with dosage of mannitol increasing. The value of Plasma osmolarity after using mannitol was higher than before using mannitol, The changes have statistical meaning(P<0.01). (3) The changes of renal function. The blood- carnine and urea nitrogen after using mannitol was higher than before using mannitol. There are noticeable difference(P<0.01). there are noticeable difference(P<0.05) in the second group at the 3day , the 5day,and the 7day after using mannitol.there are no difference between the first group and the third group.(4) The changes of blood electrolytes. The three thrapy groups show a tendency to decrease blood Na+ and raise blood K+. the dosage of mannitol is higher,the changes are more obviously. there are statistical meaning between the second group , the third group and the third group(P<0.05), there are no statistical meaning between the secondgroup and The third group. Conclusions mannitol is effective in decreasing ICH, but the effectiveness are related with many factors. We think that 0.5g/Kg.weight mannitol,1.0g/Kg.weight mannito,0.5g/Kg.weight mannitol + 20mg furosemide can decrease raised ICP. The effectiveness of 1.0g/Kg.weight mannito is better than 0.5g/Kg.weight mannitol, the effectiveness of 0.5g/Kg.weight mannito + 20mg furosemide is the best. And it can reduce ICP rebound. It is worth advocating. To keep... |
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