脑出血患者应用甘露醇的注意事项(国外英文资料).docVIP

脑出血患者应用甘露醇的注意事项(国外英文资料) Note for the use of mannitol in patients with cerebral hemorrhage The following is a guide to the use of mannitol, a guide to the use of mannitol, which is intended to help. It is a non-toxic and stable agent for high osmotic pressure dewatering agent. Mannitol intravenous injection into the body, the plasma osmotic pressure rapidly increase mainly distributed in the extracellular fluid, only a small part (about 3% of the total) converted into glycogen in the liver, most (97%) quickly via glomerular filtration, high osmotic pressure and prevent renal tubular resorption of water; It can also expand the renal artery and increase blood flow to the kidney, resulting in diuresis. So mannitol is not very good for the bodys blood sugar and is still available for people with diabetes. Because plasma osmotic pressure rapidly increases the osmotic pressure difference between the blood and cerebrospinal fluid, the water is removed from the brain tissue and cerebrospinal fluid to the blood circulation, and is expelled by the kidney. Reduce the amount of fluid in and out of the cell, thereby reducing cerebral edema and reducing intracranial pressure. Mannitol may also reduce the secretion of cerebrospinal fluid and increase its reuptake, ultimately reducing the volume of cerebrospinal fluid and reducing intracranial pressure. 此外，甘露醇还是一种较强的自由基清除剂，能较快清除自由基连锁反应中毒性强、作用广泛的中介基团羟自由基，防止半暗区组织不可逆性损伤而减轻神经功能损害，降低血液粘稠度，改善循环，故近年已将甘露醇作为神经保护剂用于临床[。　　甘露醇的降颅压作用，不仅是单纯的利尿，而且主要在于造成血液渗透压增高，使脑组织的水分吸入血液，从而减轻脑水肿、降低颅内压。　　一般在静脉注射后20分钟内起作用，2-3小时降压作用达到高峰，可维持4-6小时。常用剂量为0.25-0.5克/kg.次成人一次用量。但多年的临床实践证明，甘露醇除了能引起低钾，诱发或加重心衰，血尿、肾功不全、肾功衰竭及过敏反应外还具有下列并发症：　　⑴使脑水肿加重：甘露醇脱水降颅压有赖于BBB的完整性，甘露醇只能移除正常脑组织内的水分，而对病损的脑组织不仅没有脱水作用，而且由于血脑屏障破坏，甘露醇可通过破裂的血管进入病灶区脑组织内，造成病灶内脑水肿形成速度加快，程度加重。对于脑缺血患者，由于缺血区血管的通透性增强，甘露醇分子易由血管内进入缺血区细胞间隙，同时由于甘露醇不能够被代谢，过多的积聚导致逆向渗透，从而使缺血区水肿加重。临床动物试验也证实5次以前有降低脑压，减轻脑水肿作用。5-7次后水肿反而加重。　　⑵颅内压反跳明显：当血液内的甘露醇经肾脏迅速排出后血液渗透压明显降低从而使水分从血液内向脑组织内移动颅内压重新升高。　　⑶颅内再出血加重：以往的观点认为脑内出血是一个短暂的过程大约为30-40分钟，随着血凝块的出现而停