不同收缩压、不同降压方案对老年高血压脑出血患者预后影响的比较研究

摘要

目的：比较不同收缩压、不同降压方案对老年高血压脑出血（HICH）患者预后的影响。方法选取2011年2月—2015年6月在西安市东郊第一职工医院内科住院的老年 HICH 患者541例，按照入院时收缩压将患者分为 A 组（收缩压<180 mm Hg）179例、B 组（收缩压为180~200 mm Hg）227例和 C 组（收缩压>200 mm Hg）135例；按照降压方案不同将患者分为非强化降压组309例和强化降压组232例。比较不同收缩压患者入院时脑血肿体积、脑水肿体积、美国国立卫生研究院卒中量表（NIHSS）评分及发病90 d 改良 Rankin 量表（mRS）评分；比较不同降压方案及强化降压组不同收缩压患者入院时和治疗后7 d 脑血肿体积、脑水肿体积及发病90 d mRS 评分。结果 B 组和C 组患者入院时脑血肿体积大于 A 组，入院时 NIHSS 评分及发病90 d mRS 评分高于 A 组（P <0.05）；C 组患者入院时脑血肿体积大于 B 组，脑水肿体积大于 A 组，发病90 d mRS 评分高于 B 组（P <0.05）。入院时非强化降压组与强化降压组患者脑血肿体积、脑水肿体积比较，差异无统计学意义（P >0.05）；治疗后7 d 强化降压组患者脑血肿体积、脑水肿体积小于非强化降压组，发病90 d mRS 评分低于非强化降压组（P <0.05）。强化降压组不同收缩压患者入院时脑血肿体积、脑水肿体积比较，差异无统计学意义（P >0.05）；B 组和 C 组患者治疗后7 d 脑血肿体积、脑水肿体积大于 A 组，C 组患者发病90 d mRS 评分高于 A 组（P <0.05）。结论入院时收缩压较高的老年 HICH 患者病情更严重、预后更差，强化降压较非强化降压能更有效地改善患者病情严重程度及预后，且收缩压较低的老年 HICH 患者强化降压效果更佳。%Objective To compare the influence of systolic blood pressure and antihypertensive regimens on prognosis of aged patients with hypertensive intracerebral hemorrhage. Methods From February 2011 to June 2015,a total of 541 inpatients with hypertensive intracerebral hemorrhage were selected in the Department of Internal Medicine,the First Worker′s Hospital of Dongjiao,Xi′an,and they were divided into A group(with systolic blood pressure less than 180 mm Hg,n = 179), B group(with systolic blood pressure between 180 and 200 mm Hg,n = 227)and C group(with systolic blood pressure over 200 mm Hg,n = 135)according to systolic blood pressure,into control group(treated by routine antihypertensive regimens,n= 309) and observation group( treated by strengthening antihypertensive regimens,n = 232)according to antihypertensive regimens. Cerebral hematoma volume,cerebral edema volume and NIHSS score at admission,modified Rankin scale score after 90 days of attack were compared among A group,B group and C group;cerebral hematoma volume and cerebral edema volume at admission and after 7 days of treatment,and modified Rankin scale score after 90 days of attack were compared between control group and observation group,in patients with different systolic blood pressure of observation group. Results Cerebral hematoma volume at admission of B group,of C group was statistically significantly larger than that of A group,respectively,NIHSS score at admission and modified Rankin scale score after 90 days of attack of B group,of C group was statistically significantly higher than those of A group,respectively(P < 0. 05);cerebral hematoma volume at admission of C group was statistically significantly larger than that of B group,cerebral edema volume at admission of C group was statistically significant larger than that of A group,while modified Rankin scale score after 90 days of attack of C group was statistically significantly higher than that of B group. No statistically significant differences of cerebral hematoma volume or cerebral edema volume was found between control group and observation group at admission ( P > 0. 05 ),while cerebral hematoma volume and cerebral edema volume of observation group were statistically significantly smaller than those of control group after 7 days of treatment,and modified Rankin scale score after 90 days of attack of observation group was statistically significantly lower than that of control group(P < 0. 05). No statistically significant differences of cerebral hematoma volume or cerebral edema volume at admission was found in patients with different systolic blood pressure of observation group( P > 0. 05);of observation group,cerebral hematoma volume and cerebral edema volume of patients with systolic blood pressure equal or over 180 mm Hg were statistically significantly larger than those of patients with systolic blood pressure less than 180 mm Hg after 7 days of treatment,while modified Rankin scale score of patients with systolic blood pressure equal or over 180 mm Hg was statistically significantly higher than that of patients with systolic blood pressure less than 180 mm Hg( P < 0. 05). Conclusion The severity of illness and prognosis of aged hypertensive intracerebral hemorrhage patients with higher systolic blood pressure at admission are more severe and worse,and the effect of strengthening antihypertensive regimens is relatively better in patients with lower systolic blood pressure.