控制血压对超早期基底节区脑出血血肿扩大和神经功能的影响  

Effects of blood pressure control on hematoma expansion and neurological function in patients with ultra-early basal ganglia intracerebral hemorrhage

作　　者：巩法桃[1] 于立萍[1] 李霞[1] 田东惠[1] 田强元[1] 王忠功[1] 

机构地区：[1]山东省滨州市人民医院神经内科,256610

出　　处：《中国综合临床》2013年第4期360-363,共4页Clinical Medicine of China

基　　金：基金项目：滨州市科学技术发展计划项目（200942）

摘　　要：目的探讨控制血压对超早期基底节区脑出血血肿扩大的防治作用和神经功能的影响。方法选择2009年11月至2011年11月在滨州市人民医院神经内科住院治疗的超早期基底节区脑出血患者共120例，随机分成强化降压组和普通降压组，每组各60例。强化降压组在开始治疗后的1h内首选静脉降压药物使收缩压控制在130—140mmHg，普通降压组收缩压控制在160—180mmHg，均持续24h。分别于治疗前及治疗后24h测定CT血肿体积，治疗前及治疗后24h和2周进行美国国立卫生研究院卒中量表（NIHSS）评分，所得数据进行统计学处理。结果强化降压组患者24h时的血肿体积（11．99±6．90）ml明显低于普通降压组（14．74±7．75）ml，差异有统计学意义（t=2．049，P=0．043）、血肿扩大例数明显少于普通降压组（5例和14例，χ^2=5．070，P=0．024）；强化降压组NIHSS评分治疗前（9．74±4．49）分与治疗后24h（9．25±4．10）分比较，差异无统计学意义（P〉0．05）；强化降压组治疗前NIHSS评分（9．74±4．49）分与治疗后2周（6．28±3．68）分，组内比较差异有统计学意义（P〈0．05）；普通降压组[（9．50±4．81）分、（7．82±4．28）分]组内比较差异有统计学意义（P〈0．05）；两组治疗后2周的NIHSS评分组间比较差异有统计学意义[（6．28±3．68）分与（7．82±4．28）分，P〈0．05]。结论基底节区脑出血患者超早期强化降压治疗安全，能减少血肿扩大的发生，改善患者的早期神经功能。Objective To study the preventive and therapeutic effects of blood pressure control on hematoma expansion and neurological function in patients with ultra-early basal ganglia intracerebral hemorrhage. Methods From November 2009 to November 2011,120 patients with ultra-early basal ganglia intracerehral hemorrhage from our Hospital were enrolled and randomly divided into intensive blood pressure reduction group and general blood pressure reduction group in equal numbers （ n = 60）. The antihypertensive agent were used intravenously to reduce the systolic blood pressure by 130 - 140 mm Hg within 1 hour after treatment in patients of intensive blood pressure reduction group; and the general blood pressure reduction group was control by 160 - 180 mm Hg. The blood pressure of patients in both groups was maintained for 24 hours. The volume of haematoma in CT was measured before and 24 hours after treatment. The National Institutes of Health Stroke Scale （NIHSS） score was assessed 24 hours before and after treatmentand 14 days after treatment respectively. Statistical analyses were conducted. Results Between 24 hours before and after treatment, there were significant difference in the hematoma volume （ （ 11.99 ± 6. 90） ml vs. （ 14. 74 ± 7. 75 ） ml, t = 2. 049,P = 0. 043 ） and the number of cases of hematoma enlargement （ 5 vs. 14, χ^2 = 5.07, P = 0. 024 ） between the two groups. Between 24 hours before and after treatment, there was no significant difference in NIHSS scale in intensive blood pressure reduction group （ （ 9. 74 ± 4. 49 ） vs. （ 9. 25 ± 4. 10 ）, P 〉 0.05 ）. Between 24 hours before and 2 weeks after treatment, there were significant difference in NIHSS scale in both groups （ （9. 74 ± 4. 49） vs. （6. 28 ± 3.68 ）, P 〈 0.05 ; （9. 50 ± 4. 81 ） vs. （7. 82 ± 4. 28 ）, P 〈 0. 05, respectively）. At two weeks after treatment, there was significant difference in NIHSS scale between two groups （ （6. 28 ± 3.68 ） vs. （7.82 ± 4. 28） ,P 〈 0. 0

关 键 词：脑出血 基底节区 强化降压 血肿扩大 

分 类 号：R74[医药卫生—神经病学与精神病学]