超早期强化降压治疗对基底节区脑出血的影响

Effects of super-early strengthening antihypertensive therapy on basal ganglia intracerebral hemorrhage

目的探讨超早期强化降压治疗对基底节区脑出血的影响。方法120例超早期基底节区脑出血患者随机分成强化降压组和普通降压组，每组60例，分别在开始治疗后的lh内用静脉降压药物使收缩压控制在130—140mmHg（1mmHg=0．133kPa）、160～180mmHg，并维持24h。于治疗前、后进行美国国立卫生研究院卒中量表（NIHSS）评分、改良Rankin量表（mRS）评分和头颅CT检测，计算血肿量、血肿扩大例数和水肿量，进行组间比较。结果治疗后14d时强化降压组NIHSS评分明显低于普通降压组（P〈0．05）。强化降压组治疗后90d时mRS评分为中重度残疾的比例（25．O％，15／60）明显低于普通降压组（43，3％，26／60）（P〈0．05）。强化降压组治疗后24h时血肿量明显小于、血肿扩大例数明显少于普通降压组（均P〈0．05）。强化降压组治疗后5d、14d时水肿量明显小于普通降压组（均P〈0．05）。结论基底节区脑出血患者超早期强化降压治疗能减少血肿扩大、减轻脑水肿、改善患者的神经功能。

Objective To study the effects of super-early strengthening antihypertensive therapy on basal ganglia intracerebral hemorrhage. Methods One hundred and twenty patients with super-early basal ganglia intracerebral hemorrhage were randomly divided into strengthening antihypertensive group and general antihypertensive group, and 60 cases in each group. The antihypertensive agent were used intravenously to reduce the systolic blood pressure to level of 130 - 140 mmHg （ 1 mmHg =0. 133 kPa） and 160 - 180 mmHg, respectively, within 1 h after treatment, then maintained for 24 h. Before and after treatment, the National Institutes of Health Stroke Scale （NIHSS） and modified Rankin Scale （mRS） were assessed. Brain CT scanning were performed. The hematoma volume, number of cases of hematoma enlargement and edema volume were measured. The data was statistically compared between groups. Results The NIHSS score of patients in strengthening antihypertensive group was significantly lower than it in general antihypertensive group at 14 days after treatment （P 〈 0.05 ）. At 90 d after treatment, the proportion of moderate and severe disability assessed by mRS in strengthening antihypertensive group （25.0% , 15/60）was significantly lower than it in general antihypertensive group （43.3 %, 26/60 ） （P 〈 0. 05 ）. The hematoma volume and number of cases of hematoma enlargement in strengthening antihypertensive group were significantly less than those in general antihypertensive group at 24 h after treatment （ all P 〈 0.05 ）. The edema volumes in strengthening antihypertensive group were significantly less than those in general antihypertensive group at 5 d and 14 d after treatment （all P 〈 0. 05）. Conclusions Super-early strengthening antihypertensive therapy could reduce the incidence of hematoma enlargement and the degree of cerebral edema, and improve the neurological function of patients with basal ganglia intracerebral hemorrhage.