早期差别化降血压治疗急性脑出血的疗效分析

Early differential antihypertensive strategies in treatment of patients with acute cerebral hemorrhage

目的比较早期差别化降压治疗急性脑出血患者的临床疗效。方法将104例急性脑出血患者按入院时间顺序分为观察组和对照组各52例；出血量〈30ml为小出血量，出血量I〉30ml为大出血量；对观察组患者在开始治疗后1h先静脉降压，使收缩压达到140-160mmHg（1mmHg=0．133kPa）；将对照组患者的收缩压早期控制在≥180mmHg，比较治疗前后两组患者的血肿体积和NIHSS评分。结果观察组中小出血量患者的总显效率为86．1％，显著高于对照组的54．3％（P〈0．05）；观察组中小出血量患者在治疗3d时血肿体积增大值显著低于对照组（P〈0．05）；治疗28d时，观察组小出血量患者的NIHSS评分显著低于对照组（P〈0．05）；两组大出血量患者的各指标比较，差异均无统计学意义（P〉0．05）。结论早期强化降压治疗可以提高小出血量急性脑出血患者的疗效，改善患者的神经功能缺损情况；但对大出血量患者无明显的临床效果。

Objective To explore the clinical efficacy of differential antihypertensive treatment strategies at early stage on patients with acute cerebral hemorrhage. Methods A total of 104 patients with acute cerebral hemorrhage were randomly divided into trial group and control group （n = 52/group）. The trial group was given intravenous antihypertensive drugs so as that their systolic pres- sure went down to 140 - 160 mmHg within 1 hour （ 1 mmHg =0. 133 kpa）. The control group＇ systolic pressure was decreased and maintained at 180 mmHg. The hematoma volume and NIH stroke scale （NIHSS） of the two groups were compared. Results The total effective rate of the patients with small amount of bleeding of the trial group was 86.1% , significantly higher than that of the control group＇ s 54.3 % （P 〈 0.05 ）. Hematoma size increase of the patients with small amount of bleeding was significantly lower in the trial group than in the control group （P 〈 0.05 ）. NIHSS scores of the patients with small amount of bleeding was significantly lower in the trial group than in the control group （P 〈 0.05）. However, for the patients with large amount of bleeding, there were no statistical differences in the above indexes between the two differential strategies （ P 〉 0.05 ）. Conclusion Active antihypertensive therapy may inhibit early hematoma volume, improve prognosis and enhance clinical efficacy for the patients with small bleeding, in spite of no clinical significance in those with large amount of bleeding.