急性高血压性脑出血患者的早期血压管理与预后关系的一项前瞻性研究  

A prospective study on the relationship between early blood pressure management and prognosis in patients with acute hypertensive intracerebral hemorrhage

作　　者：王煜 秦永明 郭传军 吴晓飞[2] WANG Yu;QIN Yongming;GUO Chuanjun;WU Xiaofei(Affiliated the Third People′s Hospital of Bengbu,Bengbu Medical College,Bengbu Anhui 233000,China)

机构地区：[1]蚌埠医学院附属蚌埠第三人民医院,安徽蚌埠233000 [2]蚌埠医学院第一附属医院,安徽蚌埠233000

出　　处：《中国急救复苏与灾害医学杂志》2024年第2期183-186,190,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：安徽省卫生健康委科研项目(编号:AHWJ2021b139)。

摘　　要：目的 分析在急性高血压导致的脑出血患者中进行早期积极的血压管理对患者的血压变化、血肿控制和预后生活质量的影响。方法 便利抽样选取2020年1月—12月急诊入住蚌埠三院急诊内科及EICU的符合纳入标准的急性脑出血患者39例作为对照组,给予常规治疗,根据血压水平缓慢降压,即24 h内收缩压(SBP)控制在180 mmHg以内;2021年1月—12月的急性脑出血患者39例作为观察组,给予强化降压,持续泵入药物乌拉地尔,要求24 h SBP控制在130~140 mmHg。比较两组患者血压变化、血肿控制情况和发病90 d后的功能恢复(改良的Rankin量表)和生活自理能力(Barthel Index)。结果 干预前两组患者收缩压、血肿量差异无统计学意义(P>0.05);干预后,观察组SBP在用药10 min、用药60 min均下降,且低于对照组,但差异无统计学意义(P>0.05);用药120 min和用药24 h时差异比较明显,显著低于对照组(P<0.01)。观察组舒张压(DBP)在用药60 min、用药120 min和用药24 h时均低于对照组,差异有统计学意义(P<0.01);观察组90 d预后良好的人数(27人)高于对照组(24人),预后不良的人数(12人)少于对照组(15人),但组间差异无统计学意义(P>0.05),且两组的生活自理能力的差异无统计学意义(P>0.05)。结论 在急性高血压性脑出血患者中使用乌拉地尔进行强化降压(SBP130~140 mmHg),可以达到控制血压和减缓血肿扩大的效果,但对患者的生存率及长期生活自理能力的改善并不明显。Objective To study the effects of early blood pressure management on blood pressure changes,hematoma control and prognostic quality of life in patients with acute hypertension intracerebral hemorrhage(AHICH).Methods Thirty-nine patients with AHICH who were admitted to emergency room or EICU of the Third Hospital of Bengbu from January 2020 to December 2020 were control group.All patients received routine treatments and slowly reduced blood pressure which systolic blood pressure(SBP)was controlled below180 mmHg within 24 hours.Another 39 patients with AHICH who were admitted to emergency room from January 2021 to December in 2021 were the observation group.All patients were treated with continuous infusion of urapidil.SBP was controlled in between 130-140 mmHg during the first 24 hours.The changes of blood pressure,hematoma control,functional recovery(modified Rankin scale)and self-care ability(Barthel Index)were compared between the two groups.Results There was no significant difference in SBP and hematoma volume between the two groups before intervention,but after intervention,the SBP in 10 min and 60 min in the observation group was lower than that in the control group,but there was no significant difference between the two groups(P>0.05).There was a significant difference in SBP at 2 hours and 24 hours after treatment between two groups(P<0.05).The diastolic blood pressure(DBP)in the observation group was significantly lower than that in the control group at 1 hour,2 hours and 24 hours after treatments(P<0.01).There was no significant difference in prognosis and self-care ability between the two groups(P>0.05).Conclusion Intensive hypotension with urapidil in patients with AHICH can effectively control blood pressure and slow down the expansion of hematoma,but it doesn’t significantly improve the patient′s survival rate and long-term self-care ability in our study.

关 键 词：急性脑出血 乌拉地尔 强化降压 血肿扩大 预后 

分 类 号：R743.2[医药卫生—神经病学与精神病学]