| Objective:To systematically evaluate the effectiveness and safety of mannitol treatment on patients with acute cerebral hemorrhage within 24 hours since occur.Methods:We searched CBM(1989-2008.12),The Cochrane Library (Issue3,2008),VIP(1989-2008.12),PubMed(1989-2008.12),Ovid(1989-2008.12). Randomized-comparable-trails(RCT,Randomized-based-trails) satisfying our search criteria were included,and languages are English and Chinese.The search were conducted and extracted by the criteria,by two independent evaluators.Under the quality evaluation criteria of Cochrane Reviewer's Handbook 5.0 RCT,the quality of included studies was assessed.The software of RevMan 5.0,Meta analysis was used to see if there was low heterogeneity.Results:The primary reviewing included 200 articles,and 14 RCT articles were admitted after selection,and 1255 participants were included in the review. There are 6 RCT studies to show the effectiveness of mannitol treatment using CSS or NIHSS score,although their evaluations are somehow subjective and therefore there would be great clinical heterogeneity among them.Among the 6 RCT studies, there were 4 studies conducted by comparing mannitoal to furosemide.Using Meta-analysis,it is concluded that,the rate for continued hematoma after using mannitol was twice as much as of using furosemide(68/187 versus 31/187),which is statistically significant(RR=2.19,95%CI(1.40～3.33),P＜0.0001).Others conclusions drawn from the studies are,the rate of hematoma enlargement using small dosage(125 ml) of mannitol after 24 hours of stroke incident was lower than those using big dosage(250 ml) within 6 hours of stroke incident.Conclusions:There is currently not enough evidence to support the routine use of mannitol in acute stroke patients within 24 hours of incident,instead, furosemide should be a choice of better safety.Further trials of big sample,high quality,under rigid scientific experimental process are needed to test whether mannitol is beneficial in acute stroke. |
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