丙泊酚对高血压脑出血患者内镜术后血压管理和再出血预防的价值

Significances of propofol in blood pressure control and prevention of re-hemorrhage after endoscopic surgery for hypertensive intracerebral hemorrhage

目的观察高血压脑出血患者内镜术后血压管理和再出血发生情况,探讨丙泊酚对其的临床治疗价值。方法 117例高血压脑出血手术患者,根据术后治疗方法分为常规治疗组72例和丙泊酚治疗组45例,常规治疗组采用乌拉地尔联合硝酸甘油(必要时)持续泵注进行治疗,丙泊酚治疗组采用丙泊酚持续泵注12 h联合乌拉地尔持续泵注进行治疗。比较2组术后24 h应用乌拉地尔剂量、应用硝酸甘油剂量、颅高压峰值、颅内压及24 h气管切开率,比较2组术后72 h肺部感染发生情况、再出血发生率、继发性大面积脑梗死/脑水肿发生率及术后6个月神经功能预后情况。结果术后24 h,丙泊酚治疗组应用乌拉地尔剂量[(106.27±80.28)mg]、硝酸甘油剂量[(98.19±57.67)mg]、颅高压峰值[(15.33±4.95)mm Hg]、颅内压[(11.73±5.09)mm Hg]、气管切开率(46.67%)低于常规治疗组[(288.06±39.39)mg、(164.35±54.82)mg、(19.47±3.66)mm Hg、(15.97±3.81)mm Hg、68.06%](P<0.05);术后72 h,丙泊酚治疗组肺部感染率(8.89%)和再出血发生率(0)低于常规治疗组(26.39%、8.33%)(P<0.05),继发性大面积脑梗死/脑水肿发生率(2.22%)与常规治疗组(11.11%)比较差异无统计学意义(P>0.05);术后6个月,丙泊酚治疗组满意恢复率(97.78%)高于常规治疗组(90.28%)(P<0.05)。结论高血压脑出血内镜术后持续泵注丙泊酚治疗12 h有利于强化患者术后血压和颅内压稳定、降低再出血和肺部感染发生率,提高长期神经功能预后。

Objective To observe the blood pressure control and prevention of re-hemorrhage after endoscopic surgery for hypertensive intracerebral hemorrhage, and to investigate the clinical significance of propofol. Methods Totally 117 patients with hypertensive intracerebral hemorrhage were divided into routine treatment group(n=72) and propofol treatment group(n=45) according to the postoperative treatment. Routine treatment group received intravenous pumping of urapidil in combination with nitroglycerin if needed. Propofol treatment group received intravenous pumping of propofol for 12 h in combination with urapidil. The dosages of urapidil and nitroglycerin, the peak value of intracranial hypertension, intracranial pressure and tracheotomy rate 24 h after operation were compared between two groups. The incidences of pulmonary infection, re-hemorrhage and secondary massive cerebral infarction/encephaledema 72 h after operation, and the prognosis of neurological function 6 months after operation were compared between two groups. Results The dosage of urapidil((106.27±80.28) mg), the dosage of nitroglycerin((98.19±57.67) mg), the peak value of intracranial hypertension((15.33±4.95) mm Hg), intracranial pressure((11.73±5.09) mm Hg) and tracheotomy rate(46.67%) in propofol treatment group were lower than those in routine treatment group((288.06±39.39) mg,(164.35±54.82) mg,(19.47±3.66) mm Hg,(15.97±3.81) mm Hg, 68.06%) 24 h after operation(P<0.05). The incidences of pulmonary infection(8.89%) and re-hemorrhage(0) in propofol treatment group were lower than those in routine treatment group(26.39%, 8.33%) 72 h after operation(P<0.05), and the incidence of secondary massive cerebral infarction/encephaledema showed no significant difference between propofol treatment group(2.22%) and routine treatment group(11.11%)(P>0.05). The satisfactory recovery rate was higher in propofol treatment group(97.78%)than that in routine treatment group(90.28%)(P<0.05).Conclusion Continuous pumping of propofol for 12 hafter endoscopic surgery in patients with hypertensive intracerebral hemorrhage is beneficial for strengthening the clinical management of blood pressure and intracranial pressure,reducing the incidences of postoperative re-hemorrhage and pulmonary infection,and improving the long-term neurological prognosis.