南方医科大学学报

南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (12): 1616-.

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早期不同的血压控制目标对高血压性脑出血患者血肿扩大及预后的影响

张洪涛，禹萌，任雅芳，张斌，张淑玲，付胜奇，张道培   

  • 出版日期:2016-12-20 发布日期:2016-12-20

Effect of different blood pressure control targets within 48 h after hypertensive cerebral hemorrhage on hematoma enlargement and prognosis

  • Online:2016-12-20 Published:2016-12-20

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摘要： 目的探讨早期不同的血压控制目标对高血压性脑出血（HCH）患者血肿扩大及预后的影响。方法2013 年1 月~2016 年7 月郑州人民医院神经内科收治的HCH患者102 例，随机分成A组（51 例）和B组（51 例），在入院48 h 内两组采用不同的 收缩压（SBP）控制目标：A组采取早期积极降压治疗，SBP 目标（130~140）mmHg；B组采取标准降压治疗，SBP 目标（170~ 180）mmHg。观察两组患者血肿变化及预后情况。结果治疗48 h后，A组患者的SBP、血肿体积及美国国立卫生研究院卒中 量表（NIHSS）均明显低于B组，Glasgou昏迷量表（GCS）明显高于B组（P<0.01或P<0.05）。治疗30 d后，A组疗效等级指标优 于B组（Z=2.331，P=0.020），差异有统计学意义；A组患者的病死率低于B组（χ2=2.772，P=0.096），但差异无统计学意义。结论 对高血压性脑出血患者实施早期积极降压治疗安全可行，能减少血肿扩大，减轻神经功能恶化，改善预后。

Abstract: Objective To study the effect of different blood pressure control targets on hematoma enlargement and prognosis in patients within 48 h after hypertensive cerebral hemorrhage (HCH). Methods Between January, 2013 and July, 2016, 102 patients with HCH were randomized into group A (51 cases) and group B (51 cases) with different systolic blood pressure (SBP) control targets within 48 h. The patients in group A were given early active antihypertensive treatment with SBP control target of 130-140 mm Hg; those in group B received standard antihypertensive treatment with SBP control target of 170-180 mm Hg. The changes in the volume of hematomas and the patients’ prognosis were compared between the two groups. Results After 48 h of treatment, SBP, hematoma volume and the National Institutes of Health Stroke Scale (NIHSS) score were significantly lower and Glasgou Coma Scale (GCS) score was significantly higher in group A than in group B (P<0.01 or 0.05). After 30 days of treatment, the patients in group A showed significantly better indicators of treatment efficacy than those in group B (Z=2.331, P=0.020). The mortality rate was lower in group A than in group B, but the difference was not statistically significant (χ2=2.772, P=0.096). Conclusion Early active antihypertensive treatment is safe and feasible in patients with HCH and can reduce the enlargement of the hematomas, alleviate deterioration of neurological function, and improve the prognosis of the patients.