目 的 探讨CT辅助甘露醇 不 同 应 用 时 机 对 急 性 脑 出 血 ( a c u t e intracerebral hemorrhage，AICH)患者 血肿扩大、脑水肿、血清AQP4及预后的影 响。方法 按照随机数字表法将AICH(幕 上出血)患者均分为观察组和对照组各40 例，两组患者入院后即进行头颅CT检查， 对照组明确诊断后即开始进行甘露醇治 疗，观察组以CT检查结果为指导，对重度 出血者立即进行甘露醇治疗，对轻中度 出血者发病6h后开始进行甘露醇治疗， 比较两组患者治疗效果。结果 观察组治 疗后48h血肿增大、继续出血或再出血发 生率低于对照组，差异有统计学意义(P ＜0.05)；观察组治疗2周总有效率高于对 照组，死亡率低于对照组，差异有统计 学意义(P＜0.05)；观察组治疗后1周、2 周神经功能缺损评分(NIHSS)评分、脑血 肿、颅内水肿及血清AQP4水平均低于对照 组，差异有统计学意义(P＜0.05)。结论 在头颅CT检查辅助下适宜延迟甘露醇用药 时间能够提高预后效果，降低血肿增大、 继续出血或再出血发生风险。

Objective To explore the influence on the hematoma enlargement, edema, AQP4, prognosis for the patients with acute intracerebral hemorrhage by head CT+mannitol different application time. Methods 80 cases of patients with AICH were randomly divided into observation group(40 cases) and control group(40 cases). They were all tested by head CT, the control group was treated by mannitol immediately, the observation group were treated by head CT and different mannitol application. The clinical effect was observed. Results The rate of 48h hematoma enlargement, hematoma enlargement, recurrent bleeding for the observation group were lower than the control group(P＜0.05). The scores of NIHSS, cephalophyma, intracranial edema and the levels of AQP4 after 1 week, 2 weeks for the observation group were lower than the control group(P＜0.05). Conclusion It can increase the clinical effects for the patients with acute intracerebral hemorrhage with the help of CT and different mannitol application time, which can reduce the risk of hematoma increases, continues bleeding or rehemorrhage.