| 摘要: |
| 目的 探讨脑出血急性期强化降血压治疗合理目标血压。方法 对急性起病6h内头颅CT检查证实的自发性脑出血患者81例采用随机数字表法分为研究组41例和对照组40例，采用乌拉地尔注射液静脉微泵控制血压（乌拉地尔50mg加入0.9%氯化钠溶液至50ml，先微泵快推5mg，继以100～1000滋g/min泵入，根据监测血压调整泵入速度，直至血压达到目标血压），分别于1h内控制目标收缩压至140~160mmHg，观察两组患者实际血压控制平均水平，24、72h血肿增大情况，28、90d内病死率，及改良Rankin量表、Barthelindex（BI），以评估远期临床神经功能缺损程度情况。结果研究组与对照组实际收缩压比较差异有统计学意义（P＜0.05）；研究组与对照组比较，24、72h血肿量、血肿扩大例数比较差异均无统计学意义（均P＞0.05）；两组患者28、90d病死率比较差异无统计学意义（P＞0.05），28、90dmRS评分及28dBI比较差异均无统计学意义（均P＞0.05），但90dBI研究组较对照组好，差异有统计学意义（P＜0.05）。结论脑出血急性降压治疗，正如指南所推荐的对于收缩压介于150～220mmHg的脑出血患者，立即将血压降至140mmHg是安全可行的，能改善存活者的远期生活质量。 |
| 关键词: 高血压 脑出血 血肿扩大 降压 乌拉地尔 |
| DOI： |
| 分类号: |
| 基金项目:台州市科技局课题 |
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| Rational target of blood pressure control for patients with cerebral hemorrhage |
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DU Chongjun,CAI Hongliu,YIN Shaowen,SHAO Zhaohun,YANG Guojun,YAN Qibei
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the Sencond Hospital of Linhai
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| Abstract: |
| Objective To investigate the rational target of blood pressure control by intensive antihypertensive treat- ment for patients with cerebral hemorrhage. Methods Eighty one patients with spontaneous intracerebral hemorrhage (ICH) confirmed by brain CT scan within 6h after acute onset were admitted in ICU from October 2012 to December 2014. Patients were randomly assigned to target systolic blood pressure as 140mmHg (study group, n=41) or 160mmHg (control group, n=40). Inten- sive antihypertensive therapy was given in both groups by intravenous injection of Urapidil until the target systolic blood pressure was reached within 1h. Observations The actual average level of blood pressure, hematoma enlargement after 24h and 72h, mor- tality rate after 28d and 90d were observed in two groups; long-term clinical neurological function defect was evaluated with re- vised Rankin scale and Barthel index score. Results There was significant difference in actual systolic blood pressure between two groups (P＜0.05). There were no significant differences in hematoma volume after 24 and 72s, the rate of hematoma expan-
sion, mortality rate after 28 and 90d, mRS score after 28 and 90d, and BI index after 28d between two groups (all P ＞0.05). How- ever the BI index after 90d in study group was better than that in control group (P＜0.05). Conclusion For ICH patients with sys- tolic blood pressure between 150～220mmHg, it is safe and feasible to lower the blood pressure to140 mmHg by applying acute antihypertensive, which may improve long-term quality of life of patients. |
| Key words: High blood pressure Cerebral hemorrhage Hematoma expansion Antihypertensive Urapidil |
