乌拉地尔强化降压治疗对高血压性脑出血患者血肿扩大的影响

Effects of intensively antihypertensive therapy by Urapidil on hematoma enlargement in patients with hypertensive intracerebral hemorrhage

目的探讨乌拉地尔强化降压治疗对高血压性脑出血患者血肿扩大的影响。方法将146例高血压性脑出血患者随机分为强化降压组(强化组,75例,微量泵静脉注射乌拉地尔,平均动脉压目标值为110 mmHg)和常规降压组(对照组,71例,口服卡托普利,平均动脉压目标值为130 mmHg)。观察治疗后两组血肿体积、血肿扩大率、美国国立卫生研究院卒中量表(NIHSS)评分,以及死亡率和药物不良反应的情况。结果治疗24 h后强化组血肿平均体积[(11.9±9.5)m l]、血肿扩大率(14.7%,11例)及NIHSS评分[(7.2±5.0)分]与对照组[(13.2±9.9)m l、(31.0%,22例)、(8.9±6.8)分]比较,差异有统计学意义(均P<0.05)。发病30 d后强化组NIHSS评分[(4.6±3.4)分]显著低于对照组[(5.7±4.1)分](P<0.01);死亡率(5.3%)较对照组(9.9%)下降,但差异无统计学意义;两组不良反应差异无统计学意义。结论乌拉地尔强化降压治疗可预防高血压性脑出血患者发生血肿扩大,并且安全可靠。

Objective To investigate the effects of intensively antihypertensive therapy by Urapidil on hematoma enlargement in patients with hypertensive intracerebral hemorrhage（HICH）.Methods Hundred and four-six HICH patients were randomly divided into intensively antihypertensive group（intensive group,75 cases,Urapidil was intravenous injected by micro-pump,the target value of mean arterial pressure was 110 mmHg） and the conventional antihypertensive group（control group,71 cases,Captopril was taken,the target value of mean arterial pressure was 130 mmHg）.The changes of hematoma volume and score of NIHSS were observed after treatment,as well as mortality and adverse drug reaction.Results Twenty-four h after treatment in intensive group,the average volume of hematoma [（11.9±9.5） ml],the rate of hematoma enlargement（14.7%,11 cases）,and the score of NIHSS（7.2±5.0） were significantly differences compared with the control group [（13.2±9.9）ml,（31.0%,22 cases）,（8.9±6.8）scores]（all P0.05）.Thirty d after onset,the score of NIHSS（4.6±3.4） in intensive group was significant lower than control group（5.7±4.1）（P0.01）;the mortality rate（5.3%） was lower than control group（9.9%）,but the difference was no statistically significant.The adverse reactions between the two groups was no significant different.Conclusion Therapy of Urapidil intensive antihypertension can prevent hematoma enlargement of HICH patients,and the method is safe and reliable.