早期强化降压治疗脑出血对血肿周围水肿的影响观察

摘要

Objective To observe the effects of early intensive blood pressure ( BP )-lowering treatment on the peri-hematomal edema ( PE ) in acute intracerebral hemorrhage ( ICH ). Methods One hundred and twenty-one patients were randomly assigned to early intensive lowering of BP( IG, n =62 ) and standard guideline-based management of BP groups( SG, n = 59 )with routine therapy. Within onset 6 hours, the dose of 25 mg sodium nitroprusside and 250 ml of normal saline were intravenous drip slowly in IG, when systolic BP ( SBP ) ≥ 150 mmHg, so as to make SBP reached target level ≤ 140 mmHg in 1 hour, maintained 24 hours, then they were treated depending on the conditions of BP. The same ways were taken in SG when SBP≥l80 mmHg. Repeat CT examinations ( 24 and 72 hours, 7 and 14 days) were performed to observe the changes of PE; and comparison the curative effects. Results The volume of PE in SG increased more than it in IG when onset 24 hours, but the difference was not statistical significant( P >0. 05 ). It increased obviously in IG and SG when onset 72 hours, the difference was statistical significant (P <0. 05 ). It increased most obvious in IG and SG when onset 7 days. In onset 14 days, it reduced more obvious than in 7 days, and it was more significant in IG, the difference was statistical significant (P <0. 01 ). Total efficiency in IG was obviously better than in SG when onset 90 days( 91. 9% vs 78. 0% , P < 0. 05 ). Conclusion Early intensive antihypertensive therapy could reduce the edema volume around the hematoma and reduce the cerebral edema, improved the quality of life in patients with ICH.%目的 观察早期强化降压治疗脑出血(ICH)对血肿周围水肿的影响.方法 ICH患者121例随机分为早期强化降压组(强化组62例)和指南指导降压组(指南组59例),2组均采用常规治疗,强化组在发病后6h内收缩期血压≥150 mmHg时,即予以硝普钠25 mg+生理盐水250 ml缓慢静脉滴注,使收缩压在1h内达到目标值≤140 mmHg,维持静脉滴注24h,而后视血压情况进行处理.指南组在发病后收缩期血压≥180 mmHg时,予以硝普钠静脉滴注,方法同上.2组均于发病后24h、72h、7d、14d时复查头颅CT,以了解血肿周围水肿变化情况,并进行疗效对比.结果 发病后24h指南组血肿周围水肿体积较强化组增大,但差异无统计学意义(P＞0.05).72h时2组血肿周围水肿体积均明显增大,差异有统计学意义(P＜0.05);7d时2组血肿周围水肿体积增大最为明显,14d时2组血肿周围水肿体积均较7d时缩小,强化组较指南组减少明显,2组差异均有统计学意义(P＜0.01).90d时强化组总有效率明显高于指南组(91.9% vs 78.0% P＜0.05).结论 早期强化降压治疗减少血肿周围水肿体积,减轻脑水肿,患者生活质量明显提高.