早期不同的血压控制目标对高血压性脑出血患者血肿扩大及预后的影响  

Effect of different blood pressure control targets within 48 h after hypertensive cerebral hemorrhage on hematoma enlargement and prognosis

作　　者：张洪涛[1] 禹萌[1] 任雅芳[1] 张斌[1] 张淑玲[1] 付胜奇[1] 张道培[1] 

机构地区：[1]河南省郑州人民医院神经内科一病区,河南郑州450000

出　　处：《南方医科大学学报》2016年第12期1616-1620,共5页Journal of Southern Medical University

基　　金：国家重点基础研究发展计划(973计划)(2012CB517800)~~

摘　　要：目的探讨早期不同的血压控制目标对高血压性脑出血（HCH）患者血肿扩大及预后的影响。方法 2013年1月~2016年7月郑州人民医院神经内科收治的HCH患者102例,随机分成A组（51例）和B组（51例）,在入院48 h内两组采用不同的收缩压（SBP）控制目标：A组采取早期积极降压治疗,SBP目标（130~140）mm Hg;B组采取标准降压治疗,SBP目标（170~180）mm Hg。观察两组患者血肿变化及预后情况。结果治疗48 h后,A组患者的SBP、血肿体积及美国国立卫生研究院卒中量表（NIHSS）均明显低于B组,Glasgou昏迷量表（GCS）明显高于B组（P〈0.01或P〈0.05）。治疗30 d后,A组疗效等级指标优于B组（Z=2.331,P=0.020）,差异有统计学意义;A组患者的病死率低于B组（χ2=2.772,P=0.096）,但差异无统计学意义。结论对高血压性脑出血患者实施早期积极降压治疗安全可行,能减少血肿扩大,减轻神经功能恶化,改善预后。Objective To study the effect of different blood pressure control targets on hematoma enlargement and prognosis in patients within 48 h after hypertensive cerebral hemorrhage（HCH）. Methods Between January, 2013 and July, 2016, 102 patients with HCH were randomized into group A（51 cases） and group B（51 cases） with different systolic blood pressure（SBP） control targets within 48 h. The patients in group A were given early active antihypertensive treatment with SBP control target of 130-140 mm Hg; those in group B received standard antihypertensive treatment with SBP control target of 170-180 mm Hg. The changes in the volume of hematomas and the patients＇ prognosis were compared between the two groups.Results After 48 h of treatment, SBP, hematoma volume and the National Institutes of Health Stroke Scale（NIHSS） score were significantly lower and Glasgou Coma Scale（GCS） score was significantly higher in group A than in group B（P〈0.01 or 0.05）.After 30 days of treatment, the patients in group A showed significantly better indicators of treatment efficacy than those in group B（Z=2.331, P=0.020）. The mortality rate was lower in group A than in group B, but the difference was not statistically significant（χ2=2.772, P=0.096）. Conclusion Early active antihypertensive treatment is safe and feasible in patients with HCH and can reduce the enlargement of the hematomas, alleviate deterioration of neurological function, and improve the prognosis of the patients.

关 键 词：血压 控制目标 高血压性脑出血 血肿扩大 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R544.1[医药卫生—临床医学]