血压变异性及镇静治疗对高血压脑出血患者术后预后的影响

Effect of Blood Pressure Variability and Sedation Therapy on Postoperative Prognosis of Patientswith Hypertensive Cerebral Hemorrhage

【目的】探讨血压变异性（BPV）及镇静治疗对高血压脑出血患者术后预后的影响。【方法】选择2011年4月至2015年3月于本院接受手术治疗的78例高血压脑出血患者作为研究对象，根据患者预后情况将其分为预后良好组和预后不良组。记录术后24h患者每小时平均收缩压（SBP）、舒张压（DBP），24h收缩压标准差（24hSBPSD）、舒张压标准差（24hDBPsD），计算患者24h收缩压变异（24hSBPARV）及24h舒张压变异（24hDBPARV）情况，观察患者疾病转归情况及其与BPV的相关性，分析镇静治疗对高血压脑出血术后再出血的临床作用。【结果】①预后不良组血肿破入脑室所占比例（64．6％）高于预后良好组（40．o％），其镇静治疗所占比例（27．1％）低于预后良好组（86．7％），且预后不良组24hSBPSD、24hDBPSD、24hSBPARV、24hDBPARV均高于预后良好组，差异有统计学意义（P〈0．05）；②多因素分析结果显示：镇静治疗、破入脑室、24hSBPSD、24hDBPSD、24hSBPARV、24hDBPARV均为影响高血压脑出血患者预后的独立危险因素；③镇静组术后1h、12h躁动发生率均明显低于非镇静组（P〈0．05）；④镇静组术后再出血发生率（5．13％）低于非镇静组（25．64％），差异有统计学意义（P〈0．05）。【结论]BPV与高血压脑出血患者术后转归相关，采用镇静治疗可降低患者术后再出血发生率。

[Objective] To investigate the effect of blood pressure variability （BPV） and sedation therapy on the prognosis of patients with hypertensive cerebral hemorrhage after operation.[Methods]Sevety eight patients with hyper- tensive cerebral hemorrhage who were treated in our hospital from April 2011 to March 2015 were selected and divided in- to good prognosis group and poor prognosis group according to the patient＇s prognosis. The average systolic blood pressure （SBP） in 24 h and diastolic blood pressure （DBP） in 24h were recorded after surgery, and 24 h systolic blood pressure standard deviation （SD 24hSBP）, diastolic blood pressure standard deviation （SD 24hDBP）. 24hSBP ARV and 24hDBP ARV were calculated. Patient＇s disease outcome and its correlation with BPV were observed, and the clinical effect of seda- tion therapy on hypertensive cerebral hemorrhage after operation was analyzed.[Results]（1）The proportion of hematoma breaking into ventricle in the poor prognosis group （64.6 % ） was higher than that in the good prognosis group （40.0 % ）. The proportion of sedative treatment （27.1%） was lower than that in the good prognosis group （86. 7 %）. 24hSBP SD, 24hDBP SD, 24hSBP ARV and 24hDBP ARV of the poor prognosis group were higher than those in the good prognosis group （P 〈0.05）; （2）The results of multivariate analysis showed that sedative treatment, breaking into ventricle, 24hSBP SD, 24hDBP SD, 24hSBP ARV and 24hDBP ARV were the independent risk factors influencing the prognosis of patients with hypertensive cerebral hemorrhage; （3）The incidence of restlessness in the sedation group in postoperative lh and 12h were significantly lower than those in the non-sedation group （ P 〈0.05） ; （4）The rate of rebleeding in the seda- tion group （5.1%） was lower than that in the non-sedation group （25.6%） （ P 〈0.05）. [Conclusion] Blood pressure variability is related to the postoperative outcomes in patients with hypertensive cerebral hemorrhage. The use of sedation can effectively reduce the incidence of postoperative rebleeding.