不同长期降压方案对急性高血压脑出血预后的影响  

Effects of different long-term antihypertensive schemes on prognosis of acute hypertensive cerebral hemorrhage

作　　者：谢柯 王亮[1] 凌伟华[1] 杨鹏[1] 徐峰[1] 陈雄辉[1] XIE Ke;WANG Liang;LING Wei-hua(Department of Emergency Surgery,First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院急诊外科,苏州215000

出　　处：《临床神经外科杂志》2022年第5期543-548,共6页Journal of Clinical Neurosurgery

基　　金：国家自然科学基金(82171461);苏州市科技局民生科技医疗卫生应用基础研究(SYS2020102)。

摘　　要：目的 观察不同长期降压方案对急性高血压脑出血预后及炎性因子水平的影响。方法 回顾性分析苏州大学附属第一医院于2020年1月—2021年8月收治的118例急性高血压脑出血患者的临床资料,根据患者发病前是否患有高血压及所使用的降压药物种类,将118例患者分为1组(30例,发病前未患有高血压)、2组(27例,发病前已临床诊断高血压且规范服用血管紧张素转换酶抑制剂即ACEI/ARB类降压药)、3组(31例,发病前已临床诊断高血压且规范服用钙通道阻滞剂即CCB类降压药)和4组(30例,发病前已临床诊断高血压但未治疗),其中每位患者都在发病72 h内入院,并经标准化治疗,对比四组患者入院后GCS评分、基础血压、出血部位、出血量、基础状态、炎性因子水平及出院3个月后随访的GOS评分。结果四组患者入院GCS评分、出血部位、出血量、糖尿病史、脑梗死、脑出血史、阿司匹林服用史、冠心病史、房颤史、中性粒细胞/淋巴细胞基线资料的差异均无统计学意义(P>0.05),GOS评分、基础收缩压、基础舒张压基线资料的差异具有统计学意义(P <0.05)。4组和2组、2组和1组、1组和4组、1组和3组之间两两比较,差异无统计学意义(P>0.05),2组和3组、3组和4组之间两两比较,差异具有统计学意义(P <0.05)。多重线性回归分析结果显示,1组与3组的GOS无显著性差异(P=0.794>0.050),2组与3组的GOS有显著性差异(P=0.004 <0.050),4组与3组的GOS有显著性差异(P=0.022 <0.050),收缩压(P=0.902>0.050)、舒张压(P=0.359>0.050)无显著性差异,出血量有显著性差异(P=0.000 <0.050)。结论 相较于长期服用ACEI/ARB类药物,长期服用CCB类药物的急性高血压脑出血患者结局预后更好。Objective To observe different long-term antihypertensive drugs on prognosis of acute hypertensive cerebral hemorrhage and inflammatory factor level.Methods The clinical data of 118 patients with acute hypertensive intracerebral hemorrhage admitted to the First Affiliated Hospital of Soochow University from January 2020 to August 2021 were analyzed retrospectively.According to whether the patients suffered from hypertension and the antihypertensive drugs used before the onset of the hypertensive cerebral hemorrhage,118 patients were divided into group 1(30 patients without hypertension before the onset)and group 2(27 patients,patients have been clinically diagnosed with high blood pressure before acute hypertensive cerebral hemorrhage,and standardized ACEI/ARB antihypertensive drugs),group 3(31 cases,patients have been clinically diagnosed with high blood pressure before acute hypertensive cerebral hemorrhage,and standardized CCB antihypertensive drugs)and group 4(30 cases,patients have been clinically diagnosed with hypertension before onset and have not been treated),in which each patient within 72 h of the onset of sent to our hospital,After standardized treatment,GCS scores,basal systolic blood pressure,basal diastolic pressure,bleeding sites,bleeding volume,basal state,inflammatory factor level and GOS scores in telephone follow-up 3 months after discharge were compared between the four groups.Results GCS scores,bleeding sites,bleeding volume,history of diabetes,cerebral infarction,cerebral hemorrhage,aspirin use,coronary heart disease,atrial fibrillation and neutrophil/lymphocyte(NLR)had no statistically significant difference(P>0.05).The difference of GOS score,basic systolic blood pressure and basic diastolic blood pressure baseline data was statistically significant(P<0.05).There were no significant differences between groups 4 and 2,2 and 1,1 and 4,1 and 3(P>0.05),but there were significant differences between groups 2 and 3,3 and 4(P<0.05).Multiple linear regression analysis results showed that there w

关 键 词：急性高血压脑出血 炎性因子 GCS GOS 

分 类 号：R743.34[医药卫生—神经病学与精神病学]