积极降压对脑出血早期血肿扩大的影响分析

The efficacy of intensive reduction of blood pressure for the treatment of cerebral hemorrhage

目的 探讨高血压脑出血急性期积极降压治疗对早期血肿增长的影响.方法 2010年3月至12月人院且发病在6h内的50例高血压脑出血患者,经头颅CT证实为自发性脑出血,且收缩压持续≥150 mm Hg（1 mm Hg=0.133 kPa）且≤220 mm Hg.按住院号随机数字分组法分成2组,观察组28例入院即开始降压治疗,要求在1h内使目标收缩压≤140 mm Hg,并维持此目标值；对照组22例收缩压≥180 mm Hg或平均动脉压≥130 mm Hg才开始降压治疗.24 h后复查头部CT,依据ABC/2法计算脑实质内血肿量,进行统计学分析.结果 入院后首次CT检查,观察组的平均血肿体积为（34.1 ±3.1）ml,对照组的平均血肿体积为（33.5 ±3.2）ml,2组间比较差异无统计学意义（P＞0.05）.观察组患者24h平均血肿增长率为7.1％,对照组为36.4％,2组比较差异具有统计学意义（P＜0.05）.结论 对高血压脑出血患者,早期将收缩压降到≤140 mm Hg,可减缓24h内血肿的增大.

Objective To study the safety and efficacy of intensive reduction of blood pressure for the treat- ment of acute cerebral hemorrhage. Methods A randomized control trial enrolling 50 consecutive patients with intracerebral hemorrhage admitted from March 2010 to December 2010 were randomly assigned to intensive blood pres sure reduction group （ n = 28） or guidelines blood pressure reduction group （ n = 22） （ tho guidelines set by American Association of cardiologists）. In the intensive reduction group, the systolic pressure was reduced immediately to lower than 140 mm Hg, while the blood pressure was reduced to that just below 180 mm Hg in guideline reduction group. The size of the hematoma was measured 24 h after treatment by CT scans. The outcomes were statistically analyzed with SPSS version 17.0 software. Measurement data were analyzed with t -test while numeration data were analyzed with chi square test. Results The mean values of proportional enlargement of hematoma were 7.1% in the intensive group and 36.4% in the guidelines group 24 hours after treatment （P = 0.012）. Conclusion Controlling blood pressure actively can decrease ratio early enlargement of hematoma in patients with hypertensive cerebral hemorrhage.