药物降压对高血压脑出血局部脑血流量的影响  

Effect of hypertensive agent on regional cerebral blood flow in patients with hypertensive intracerebral hemorrhage

作　　者：左右 杜娟 陈建良 赵庆锁 张少伟 

机构地区：[1]深圳市第七人民医院神经外科 [2]深圳市第七人民医院ICU [3]暨南大学第二临床医学院深圳市人民医院神经外科

出　　处：《中华急诊医学杂志》2008年第7期742-744,共3页Chinese Journal of Emergency Medicine

基　　金：深圳市科技局资助项目（200404051）

摘　　要：目的探讨不同程度药物降压对高血压脑出血患者局部脑血流量及预后的影响。方法30例高血压脑出血，测得首次入院血压，根据平均动脉压降低程度分为A组（〈10％）、B组（10—20％）、c组（〉20％），并分别于入院24h内、3—5d、12—15d行单光子发射计算机体层摄影术、头颅CT和临床疗效评定。两组间局部脑血流量下降比值差异采用t检验；两组间神经功能缺损评分、生活能力评分和再出血例数差异采用χ^2检验，应用SPSS 10．0统计学软件。结果C组局部脑血流量下降比值、神经功能缺损值和生活能力评分在各期与A、B组相比差异均有统计学意义（P〈0．05）；A组在急性期发生再出血机会与B、C组相比差异均有统计学意义（P〈0．05）。结论在HICH早期，当收缩压〉185 mmHg或舒张压〉95 mmHg时，MAP降低约15％较为安全，对患者局部脑血流量和预后影响较小。Objective To investigate effects of hypertensive agents on regional cerebral blood flow （rCBF） and prognosis in patients with hypertensive intracerebral hemorrhage （HICH）. Method Thirty patients with HICH were divided into group A,B and C according to mean arterial pressure（MAP） with various ranges of 〈 10%, 10 - 20%, and 〉 20%, respectively. Patients of three groups were checked with single photon emission computed tomography （ SPECT）, and computerized tomography of head successively, 24 hours, 3 - 5 days, and 12 -15 days after admission for the assessment of therapeutic effects. The rtes of the decrease in rCBF compared betwecn groups were analyzed with t test. Neurologic function defect scale, activities of living scale and number of rebleeding compared between two groups were analyzed by χ^2 test,respectively. Results There were statistically significant differences in the rate of the decrease in rCBF. The neurologic function defect scale and activities of living scale at 24 hours, 3 - 5 days, and 12 - 15 days after admission compared between group C and group A, and between group C and group B showed significant differences （ P 〈 0.05）. There were statistically significant differences in rebleeding during acute phase of HICH between group A and group B or group C （P 〈 0.05）. Conclusions If the systolic blood pressure is above 185 mmHg or diastolic blood pressure over 95 mmHg, it is rational and safe to lower the MAP by about 15% with hypotensive agents so as to minimize the impact on regional cerebral blood flow.

关 键 词：高血压脑出血 局部脑血流量 单光子发射计算机体层摄影术 预后 

分 类 号：R544.1[医药卫生—心血管疾病] R743.3[医药卫生—内科学]