早期强化降压治疗脑出血对血肿周围水肿的影响观察  

The therapeutic effect of early intensive blood pressure control on the perihematomal edema in acute intracerebral hemorrhage

作　　者：张海欣[1] 顾芳[2] 黄英俊[3] 王丽[1] 宋钦[4] 刘彦青[3] 王立刚[3] 

机构地区：[1]河北省保定市第二医院神经内科,071051 [2]保定市儿童医院内五科 [3]河北省保定市第二医院神经外科,071051 [4]保定市第四医院神经内科

出　　处：《疑难病杂志》2011年第12期894-896,共3页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的观察早期强化降压治疗脑出血(ICH)对血肿周围水肿的影响。方法 ICH患者121例随机分为早期强化降压组(强化组62例)和指南指导降压组(指南组59例),2组均采用常规治疗,强化组在发病后6h内收缩期血压≥150 mmHg时,即予以硝普钠25 mg+生理盐水250 ml缓慢静脉滴注,使收缩压在1h内达到目标值≤140mmHg,维持静脉滴注24h,而后视血压情况进行处理。指南组在发病后收缩期血压≥180 mmHg时,予以硝普钠静脉滴注,方法同上。2组均于发病后24h、72h、7d、14d时复查头颅CT,以了解血肿周围水肿变化情况,并进行疗效对比。结果发病后24h指南组血肿周围水肿体积较强化组增大,但差异无统计学意义(P>0.05)。72h时2组血肿周围水肿体积均明显增大,差异有统计学意义(P<0.05);7d时2组血肿周围水肿体积增大最为明显,14d时2组血肿周围水肿体积均较7d时缩小,强化组较指南组减少明显,2组差异均有统计学意义(P<0.01)。90d时强化组总有效率明显高于指南组(91.9%vs 78.0%P<0.05)。结论早期强化降压治疗减少血肿周围水肿体积,减轻脑水肿,患者生活质量明显提高。Objective To observe the effects of early intensive blood pressure（BP）-lowering treatment on the perihematomal edema（PE） in acute intracerebral hemorrhage（ICH）.Methods One hundred and twenty-one patients were randomly assigned to early intensive lowering of BP（1G,n=62） and standard guideline-based management of BP groups（SG, n=59） with routine therapy.Within onset 6 hours,the dose of 25 mg sodium nitroprusside and 250 ml of normal saline were intravenous drip slowly in IG,when systolic BP（SBP）≥150 mmHg,so as to make SBP reached target level≤140 mmHg in 1 hour,maintained 24 hours,then they were treated depending on the conditions of BP.The same ways were taken in SG when SBP≥180 mmHg.Repeat CT examinations（24 and 72 hours,7 and 14 days） were performed to observe the changes of PE; and comparison the curative effects.Results The volume of PE in SG increased more than it in IG when onset 24 hours,but the difference was not statistical significant（P0.05）.It increased obviously in IG and SG when onset 72 hours,the difference was statistical significant P0.05）.It increased most obvious in IG and SG when onset 7 days.In onset 14 days,it reduced more obvious than in 7 days,and it was more significant in IG,the difference was statistical significant P0.01）. Total efficiency in IG was obviously better than in SG when onset 90 days（91.9%vs 78.0%,P0.05）.Conclusion Early intensive antihypertensive therapy could reduce the edema volume around the hematoma and reduce the cerebral edema,improved the quality of life in patients with ICH.

关 键 词：强化降压 早期 血肿周围水肿 脑出血 

分 类 号：R743.34[医药卫生—神经病学与精神病学]