早期强化降压治疗对高血压性脑出血患者脑血流动力学的影响

摘要

Objective To investigate the effect of early intensive antihypertensive treatment on cerebral he-modynamics in patients with hypertensive cerebral hemorrhage. Methods A total of 98 patients of hypertensive cere-bral hemorrhage patients, in the Department of Internal Medicine of our hospital from January 2010 to July 2013, were divided into two groups according to different early antihypertensive target value:intensive antihypertensive treatment group (intensive group, 50 cases) and control group (48 cases). The control group was given symptomatic and support-ive treatment to reduce intracranial pressure, trophic nerve, while the intensive group, on the basis of the control group, was given micro pump intravenous administration of urapidil within 24 h after onset. The target value of mean arterial pressure (MAP) was (110 ± 5) mmHg for the intensive group and (130 ± 5) mmHg for the control group. ECG monitor was applied for blood pressure monitoring, and ABC/2 method was used to calculate theperihematomal edema zone vol-ume. Transcranial Dopper was applied to detect the peak systolic velocity (Vs), the average blood flow velocity (Vm), pulsatility index (PI), resistance index (RI) in bilateral middle cerebral artery (MCA) at admission and 24 h after treat-ment, as well as to describe the spectrum shape change. All the patients were scored at admission and 24 h after treat-ment, 7 d after treatment according to the National Institutes of Health Stroke Scale (NIHSS). Results 24 h after treat-ment, Vs, RI, Vm, PI were significantly better in the intensive group than the control group, with statistically significant differences between the two groups (P<0.05). Edema zone volume and NIHSS scores had no statistically significant dif-ference between the two groups at admission (P>0.05), which were significantly decreased 24 h, 7 d after treatment (P<0.05). Eight patients in the intensive group and 5 patients in the control group showed hypotension, and there was no sig-nificant difference between the two groups in the incidences of adverse reactions (P>0.05). Conclusion Early applica-tion of intensive antihypertensive treatment on patients with hypertensive cerebral hemorrhage helps alleviate cerebral hemorrhage with edema volume, improve the neural function recovery after cerebral hemorrhage, with no significant effect on cerebral hemodynamics.%目的：探讨早期强化降压治疗对高血压性脑出血患者血流动力学的影响。方法收集我院神经内科2010年1月至2013年7月收治的98例高血压性脑出血患者，根据早期降压目标值不同分为强化降压治疗组(强化组，50例)和对照组(48例)，对照组予降颅压、营养神经等对症及支持治疗，强化组在对照组基础上，于发病24 h内予以微量泵静脉注射乌拉地尔降压治疗，强化组平均动脉压(MAP)目标值(110±5) mmHg；对照组MAP目标值(130±5) mmHg。所有患者应用心电监护仪进行血压监测，采用ABC/2方法计算血肿周围水肿带体积，运用经颅多普勒检测仪检测两组患者入院时、治疗24 h后双侧大脑中动脉(MCA)的收缩期峰值血流速度(Vs)、平均血流速度(Vm)、搏动指数(PI)、阻力指数(RI)、描述频谱形态改变。对两组患者于入院时、治疗后24 h、治疗7 d后进行国立卫生研究院卒中量表(NIHSS)评分。结果治疗24 h后强化组和对照组Vs、RI、Vm、PI进行组间比较，强化组显著优于对照组且差异均具有统计学意义(P<0.05)。入院时强化组和对照组的出血周围水肿带体积、NIHSS评分比较差异均无统计学意义(P>0.05)；治疗24 h、第7天，强化组的血肿周围水肿带体积、NIHSS评分较对照组均显著降低(P<0.05)；强化组和对照组各有8例和5例患者出现低血压，两组不良反应发生率差异无统计学意义(P>0.05)。结论早期应用强化降压治疗有助于减轻高血压性脑出血患者脑出血周围水肿带体积，有助于改善脑出血后神经功能缺损恢复，对患者MCA血流动力学无明显影响。