早期强化降压治疗脑出血的疗效观察

Early Intensive Blood Pressure-lowering Treatment of Cerebral Hemorrhage

目的观察早期强化降压治疗脑出血的疗效。方法 122例脑出血患者按随机数字表法分为强化降压组(61例)和常规治疗组(61例),2组均予以综合治疗,在此基础上,强化降压组常规静脉泵入硝普钠强化降压,目标收缩压≤140 mm Hg(1 mmHg=0.133 kPa);常规治疗组常规降压治疗,目标收缩压≤180 mm Hg。分别于治疗前及治疗后37、d行头颅CT检查,计算血肿和水肿体积;治疗前及治疗后7、14、28 d进行神经功能缺损程度评分(NDS);治疗后28 d和90 d分别进行疗效及Barthel指数(BI)的评价。结果与治疗前相比,治疗后37、d血肿体积较治疗前增大(均P<0.01),但强化降压组较常规治疗组血肿体积增幅减少(均P<0.05);与治疗前相比,治疗后各时间点2组比较水肿体积均增大(P<0.01),但差异无统计学意义(P>0.05);强化降压组较常规治疗组治疗后NDS评分减少明显(均P<0.05);治疗后28 d和90 d强化降压组总有效率(86.89%)和显效率(21.34%)显著优于常规治疗组(总有效率63.93%,显效率9.84%)(均P<0.01)。结论强化降压治疗可减轻急性脑出血早期血肿扩大,而水肿体积未随之增大,从而改善脑出血的预后,促进神经功能的恢复,可提高近期及远期疗效。

Objective To observe the therapeutic effect of early intensive blood pressure reduction on cerebral hemorrhage.Methods A total of 122 patients with cerebral hemorrhage were randomly divided into intensive group and conventional treatment group,with 61 cases in each group.In intensive group,intravenous infusion of sodium nitroprusside was performed based on the comprehensive treatment and the target systolic blood pressure was less than 140 mm Hg（1 mm Hg=0.133 kPa）.The standard antihypertensive therapy was performed in conventional treatment group and the target systolic blood pressure was less than 180 mm Hg.Head CT examination was performed and volume of hematoma and edema was calculated in all patients before and 3,7 d after treatment.Neurological deficit scores（NDS） was examined before and 7,14,28 d after treatment,and the curative effects and Barthel Index（BI） were evaluated 28 and 90 d after treatment.Results Hematoma volume increased 3 and 7 d after treatment in the two groups（all P〈0.01）.Compared with conventional treatment,early intensive blood pressure-lowering treatment reduced the growth of hematoma（all P〈0.05）.Edema volume increased after treatment（P〈0.01）,but there was no significant difference between the two groups（P〈0.05）.Compared with conventional treatment group,NDS significantly decreased in intensive group（all P〈0.05）.The total effective rate and markedly effective rate in intensive group（86.89% and 21.34%,respectively） were significantly higher than those in conventional treatment group（63.93% and 9.84%,respectively） 28 and 90 d after treatment（all P〈0.01）.Conclusion Intensive blood pressure-lowering treatment can reduce early hematoma enlargement to improve the prognosis of cerebral hemorrhage,promote the recovery of neurological function,and improve short-and long-term outcomes in patients with acute intracranial hemorrhage.