积极降压对脑出血血肿周围继发神经元损伤及预后的影响  

Effect of intensive blood pressure reduction on peri-hematomal secondary neuronal injury and prognosis in patients with intracerebral hemorrhage

作　　者：张红[1] 杨杰[1] 殷信道[2] 徐青青[2] 周俊山[1] 

机构地区：[1]南京医科大学附属南京医院神经内科,南京210006 [2]南京医科大学附属南京医院放射科

出　　处：《中国神经精神疾病杂志》2015年第3期129-134,共6页Chinese Journal of Nervous and Mental Diseases

基　　金：南京市科技发展计划项目(编号:201001097)

摘　　要：目的比较急性期积极降压与指南推荐的标准降压对脑出血血肿周围继发神经元损伤及预后的影响。方法采用前瞻性、随机对照临床研究。将36例连续入院、发病6 h内CT证实为脑出血的患者,随机分为积极降压组和标准降压组,分别予早期积极降压(目标收缩压140 mm Hg)和按照美国心脏病协会2010年指南推荐的标准降压(目标收缩压180 mm Hg),两组患者均在降压72 h行质子磁共振波谱检查并随访90 d。比较两组72 h血肿周围区N-乙酰天门冬氨酸/肌酸(N acetyl aspartate/creatine,NAA/Cr)较对侧镜像区的下降比例及乳酸波峰值、早期神经功能缺损变化及90 d死亡/残疾率有无差异。结果共有31例患者得到可分析的谱线,积极降压组14例,标准降压组17例。72 h后积极降压组血肿侧较对侧镜像区NAA/Cr下降比例为(13.3%±4.2%),标准降压组为(11.9%±2.8%),两组下降率比较无统计学差异(P=0.308);两组早期神经功能缺损变化无统计学差异(P>0.05);两组90 d死亡/残疾率无统计学差异(P>0.05)。结论早期积极降压对脑出血血肿周围组织继发性神经元损伤及预后无明显影响。由于样本量较小,结果的稳健性尚需大样本随机对照试验进一步验证。Objective To study the influence of early intensive blood pressure （BP） lowering treatment on peri-he-matomal secondary neuronal injury and prognosis after acute intracerebral hemorrhage. Methods A randomised con-trolled trial consisting of 36 consecutive patients within 6 h of intracerebral hemorrhage onset were randomly assigned to intensive BP lowering group and guideline BP lowering group. All patients underwent MR spectroscopy at 72 h and were followed up 90 days. N Acetyl Aspartate/Creatine （NAA/Cr） and lactic acid wave around peri-hematomal at 72 h, neuro-logic function at early stage, and death and/or disability at 90d were compared between these two group. Results Spec-trum lines were obtained from thirty-one patients：14 from intensive BP lowing group and 17 from guideline BP lowering group. There was no significant difference in the percentage declines of NAA/Cr at 72 h between the two groups （13.3%± 4.2% vs. 11.9%± 2.8%, P = 0.308）. There was no statistical differences either in neurologic function at 7 d or in death and/or disability at 90 d （P〉0.05）. Conclusions Early intensive BP-lowering treatment had no role on peri-hematomal secondary neuronal injury and prognosis after acute intracerebral hemorrhage. Further high-quality and large-scale ran-domised controlled trial are necessary to verify this result.

关 键 词：脑出血 血肿 血压 预后 磁共振波谱学 

分 类 号：R743.34[医药卫生—神经病学与精神病学]