自发性脑出血患者脑灌注压监测和强化血压控制的意义

摘要

Objective To study the significance of cerebral perfusion pressure and intensive blood pressure control in post-operative patients with severe spontaneous intracerebral hemorrhage. Methods A total of 63 post-operative patients with severe spontaneous intracerebral hemorrhage were selected. The patients were divided into two groups according to the level of CPP. The patients whose CPP<60 mmHg were enrolled in group A and the patients whose CPP≥60 mmHg were enrolled in group B. The use of mannitol and other relevant variables were collected and compared. In addition,patients in group B were divided into two subgroups: controlled BP group and control group. The 28 days mortality after operation and Rankin score were accessed. Results Compared to group B,the mannitol usage was significantly larger and the 28 days mortality was significantly lower of group A (t=-10.17,χ2=6.99,P<0.05). In addition,the subgroup analysis showed that the patients in controlled BP group and control group had similar 28 days mortality (χ2=0.07,P>0.05). However,the CPP and the 3 months Rankin score in controlled BP group were significantly lower than the control group (t=-5.00,-3.01,P<0.05). Conclusion The CPP and intensive blood pressure control after operation could improve prognosis in patients with severe spontaneous intracerebral hemorrhage.%目的：探讨脑灌注压（CPP）监测和强化血压控制在严重自发性脑出血术后患者中的临床意义。方法共收集63例严重脑出血术后患者进行脑灌注压监测，根据CPP值分为两组：CPP＜60 mmHg组（A组），CPP≥60 mmHg组（B组），比较其5 d甘露醇使用量及其他临床指标。并将B组患者随机分为强化血压控制组和对照组，对其术后28 d死亡率及3个月Rankin评分进行比较。结果 A组术后5 d甘露醇用量明显大于B组，术后28 d死亡率明显低于B组，差异均有统计学意义（t=－10.17，χ2=6.99，P均＜0.05）。 B组中，强化血压控制组中CPP明显低于对照组，3个月Rankin评分优于对照组，差异均有统计学意义（t分别=－5.00、－3.01，P均＜0.05），而两组术后28 d死亡率比较，差异无统计学意义（χ2=0．07，P＞0．05）。结论严重自发性脑出血患者术后进行CPP监测和强化血压控制有助于改善患者预后。