高血压脑出血患者早期强化降压对血肿扩大的影响

Influence of early intensively antihypertensive therapy on hematoma enlargement in patients with hypertensive intracerebral hemorrhage

目的探讨高血压脑出血(ICH)患者早期强化降压治疗对血肿扩大的影响。方法选择入院时血压>180/110mmHg的ICH患者256例,随机分为强化降压组(A组,128例)及指南标准降压组(B组,128例),分别给予强化降压及指南标准降压治疗;观察24h后两组血肿体积的变化和入院时及21d时美国国立卫生研究院卒中量表(NIHSS)情况。结果A组治疗前及24h后血肿平均体积为(20.5±2.76)ml和(23.3±2.32)ml,血肿扩大11例(8.59%);B组血肿平均体积为(20.2±2.87)ml和(26.5±2.48)ml,血肿扩大29例(22.66%),两组血肿扩大率的比较差异有统计学意义(P<0.01);A组入院时及治疗21d时NIH-SS评分分别为(26.5±7.42)分及(16.5±9.26)分;B组分别为(25.8±7.93)分及(19.7±10.40)分;两组发病21d时比较差异有统计学意义(P<0.05)。结论高血压ICH早期强化降压治疗对控制血肿扩大有益。

Objective To investigate the influence of early intensively antihypertensive therapy on hematoma enlargement in patients with hypertensive intracerebral hemorrhage（HICH）.Methods 256 acute HICH patients with blood pressure 180/110 mmHg were randomly divided into two groups.A group（128 cases）was given intensively antihypertensive therapy,B group（128 cases）was given standard guideline antihypertensive therapy.The efficacy was evaluated by hematoma volume 24 h after treatment and the National Institutes of Health Stroke Scale（NIHSS）before and 21 d after treatment.Results The mean hematoma volume before and 24 h after treatment in A group were（20.5±2.76）ml and（23.3±2.32）ml,and 11 cases（8.59%）had hematoma enlargement;while the mean hematoma volume in B group were（20.2±2.87）ml and（26.5±2.48）ml,and 29 cases（22.66%）had hematoma enlargement.There was statistical difference between the two groups（all P〈0.01）.The scores of NIHSS before and 21 d after treatment in A group were（26.5±7.42）and（16.5±9.26）,while in B group were（25.8±7.93）and（19.7±10.40）.There was also statistical difference between the two groups at 21 d after treatment（P〈0.05）.Conclusion Early intensively antihypertensive therapy is helpful to control hematoma enlargement in HICH patients.