[Influence of mannitol on early enlargement of hematoma in hypertensive cerebral hemorrhage].

OBJECTIVE: To probe into the influence of mannitol on early enlargement of hematoma in hypertensive cerebral hemorrhage, and to discuss how to use mannitol correctly. METHODS: 93 patients with hypertensive supratentorial non-thalamic cerebral hemorrhage and light intracranial hypertension, and with less than 30 ml of hematoma volume determined by cranial CT within 6 h after the onset were randomly divided into a group in which mannitol was used (n = 46) or a group in which mannitol was not used (n = 47) within 24 h. Cranial CT was redone at 48 h. If the volume of hematoma increased by 33%, it was named early enlargement of hematoma. The influence of using mannitol within 24 h after the onset on early enlargement of hematoma was analyzed. RESULTS: 14(14/46) patients in the group in which mannitol was used within 24 h after the onset had early enlargement of hematoma, yet 4(4/47) patients in the group without mannitol had hematoma enlargement. There was significant difference between them (P < 0.01). No significant difference was seen between the integral of nerve function defect in the two groups when CT was done at the first time (P > 0.05). When CT was redone, the integral of nerve function defect in the group with mannitol used within 24 h was markedly higher than that in the group without mannitol (P < 0.05). 5(5/46) patients died in the former group and 1(1/47) in the latter. CONCLUSION: Improper use of mannitol within 24 h after the onset may increase the incidence of early enlargement of hematoma in patients with hypertensive cerebral hemorrhage, and exacerbate the patient's condition. For patients with hypertensive cerebral hemorrhage with light intracranial hypertension, especialy those within 24 h after the onset, mannitol should not be used blindly, in case that it enlarges the hematoma and exacerbates patient's condition.