A Systematic Review of Mannitol Therapy for Acute Ischemic Stroke and Cerebral Parenchymal Hemorrhage Comments, Opinions, and Reviews
A Systematic Review of Mannitol Therapy for Acute Ischemic Stroke and Cerebral Parenchymal Hemorrhage Comments, Opinions, and Reviews
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甘露醇治疗急性缺血性中风和脑实质出血的系统评价评论、意见和评论
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通讯作者：
M. Lakomek
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作者：
B. Erdlenbruch;V. Jendrossek;M. Marx;A. Hunold;H. Eibl;M. Lakomek
背景-据报道，甘露醇可以减少与组织损伤相关的脑水肿，并在许多国家用于治疗急性中风。综述摘要：我们检验了无混杂随机临床试验中是否有证据表明，在缺血性卒中或脑实质性出血后使用甘露醇治疗可降低短期和长期病死率和依赖性。通过Cochrane卒中评价组的标准搜索策略确定试验。进行了补充MEDLINE检索，并检查了中国脑卒中试验登记和拉丁美洲数据库LILACS。对圣保罗大学数据库中的硕士和博士学位论文以及1965-1997年巴西神经病学和神经外科医学大会的摘要进行了检索。记者联系了调查人员以获取未公布的信息。只有真正随机、无混杂的临床试验才有资格纳入。两位审稿人独立地从试验中提取数据。使用Cochrane Review Manager软件（RevMan version 4.0.4）进行数据综合分析。结论：只有1项试验符合纳入标准。纳入患者数量少，随访时间短。病死率、依赖患者的比例和副作用没有报道，也没有从调查人员那里得到。由于缺乏适当的随机试验，目前没有结论可以得出甘露醇对急性卒中的影响。在所有急性脑卒中患者中常规使用甘露醇并没有得到随机对照临床试验证据的支持。(中风。2000;31:27 . 19-27 . 22)，以比较纳入所有试验的总体结果与分析仅限于患者进行CT扫描的试验的结果。由于甘露醇可能对严重脑水肿的患者更有效，我们计划对那些意识水平下降的患者进行亚组分析。对静脉给药甘露醇的研究计划进行进一步的亚组分析。如果给予1 g/kg的甘露醇剂量，则将对试验进行单独分析，因为发现每剂量1.0 g/kg的甘露醇始终使ICP低于控制值，但每剂量1 g/kg的甘露醇并不总是降低ICP。13由于甘露醇的减水肿效果持续数小时，因此计划对每日总剂量分成3美元剂量的研究进行单独分析。计划对使用甘露醇的研究进行额外的分析。7天，因为缺血或出血性区域周围的水肿可能持续较长时间。
Background —Mannitol was reported to decrease cerebral edema associated with tissue damage and is used to treat acute stroke in many countries. Summary of Review —We tested whether there is any evidence from unconfounded randomized clinical trials that treatment with mannitol reduces short- and long-term case fatality and dependency if administered after ischemic stroke or cerebral parenchymal hemorrhage. Trials were identified by the standard search strategy of the Cochrane Collaboration Stroke Review Group. A supplementary MEDLINE search was performed, and the Chinese Stroke Trials Register and the Latin-American databank LILACS were checked. A search was performed of master’s and PhD degree theses in the databank of Sao Paulo University and in abstracts of medical congresses on neurology and neurosurgery during 1965–1997 in Brazil. Investigators were contacted for unpublished information. Only truly randomized unconfounded clinical trials were eligible for inclusion. Two of the reviewers independently extracted data from the trials. Data synthesis and analysis was performed with the use of the Cochrane Review Manager software (RevMan version 4.0.4). Conclusions —Only 1 trial fulfilled the inclusion criteria. The number of included patients was small, and the follow-up was short. Case fatality, the proportion of dependent patients, and side effects were not reported and were not available from the investigators. As a result of lack of appropriate randomized trials, currently no conclusion can be drawn on the effects of mannitol in acute stroke. The routine use of mannitol in all patients with acute stroke is not supported by evidence from randomized controlled clinical trials. ( Stroke . 2000;31:2719-2722.) be performed to compare the overall results when all trials were included with the results when the analysis was restricted to trials in which patients had a CT scan. Since mannitol might be more effective in patients with more severe brain edema, we planned to perform a subgroup analysis for those patients who had a decreased level of consciousness. A further subgroup analysis was planned for studies with intravenous administration of mannitol. Trials would be analyzed separately if a dose of $ 1 g/kg of mannitol was given because it was found that administration of $ 1.0 g/kg per dose consistently reduced ICP from control values, but dosages , 1 g/kg per dose did not always reduce ICP. 13 A separate analysis was planned for studies in which the total daily dose was divided into $ 3 doses because the edema-reducing effect of mannitol lasts for a few hours. An additional analysis was planned for studies in which mannitol was given for . 7 days because edema around the ischemic or hemorrhagic region might persist for longer periods of time.