摘要
目的观察差别化降血压治疗不同出血量的老年急性脑出血患者的临床疗效。方法选择老年急性脑出血伴高血压患者共86例，随机分为积极降压组和常规降压组，每组各43例。出血量〈30ml为小出血量，出血量≥30ml为中大出血量。积极降压组在开始治疗后的lh内首选静脉降压药物使收缩压降至140～160mmHg；常规降压组早期控制收缩压至180～200111121Hg。分别于治疗前及治疗后3d、7d时测定血肿体积，治疗前及治疗后7d和28d进行美国国立卫生研究院卒中量表（NIHSS）评分，评价治疗后28d的临床疗效。结果积极降压组的小出血量患者治疗后28d的NIHSS评分（4．8±2．7）分、治疗后3d的血肿体积增大（2．4±0．6）ml和治疗第28天总显效率86．67％均优于常规降压组（7．6±3．9）分、（8．1±3．1）ml和53．13oA（t=3．27、9．84，X3=8．20，均P〈0．01），而中大出血量患者的组问比较差异均无统计学意义（均P〉0．05）。结论积极降压治疗能抑制小出血量脑出血患者早期血肿体积增大、改善患者预后、提高临床疗效；而对中大出血量患者并无明显的临床作用，甚至可能对部分患者不利。
Objective To observe the therapeutic efficacy of differential antihypertensive treatments on the elderly acute cerebral hemorrhage with different amounts of bleeding. Methods 86 elderly patients with acute cerebral hemorrhage combined by hypertension were randomly divided into two groups： active antihypertensive group and regular antihypertensive group （n = 43 for each group）, among which 62 cases aged （68.9± 5.3） years were in hemorrhage of small amount （volume 〈30 ml）, 24 cases aged （70.8±5.7） years in large amount hemorrhage （volume ≥30 ml）. The patients in active antihypertensive group received intravenous antihypertensive drugs within 1 hour of treatment in the following 7 d to reach systolic pressure 140-160 mm Hg. In contrast, in the control group the patients＇ systolic pressure reached 180-200 mm Hg at early stage. The hematoma volume was measured by CT before treatment and at 3 d and 7 d after treatment. NIH stroke scale （NIHSS） was used before treatment and 7 d and 28 d after treatment Results In the patients with small amount of bleeding, NIHSS scores and the total efficacy rate at 28 d after treatment and hematoma size at 3 d after treatment were better in active antihypertensive group than in regular antihypertensive group [（4. 8±2.7） scores, 86.67% and （2.4±0. 6） ml vs. （7.6±3.9） scores, 53. 13% and （8. 1± 3.1） ml, all P〈0. 01]. However, for the patients with large amount of bleeding, there were no statistical differences in the above indexes between the two differential strategies （all P〉0.05）. Conclusions Active antihypertensive therapy may inhibit early hematoma volume, improve prognosis and enhance clinical efficacy for the patients with small bleeding, but no clinical significance for the patients with large amount of bleeding.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2012年第4期302-304,共3页
Chinese Journal of Geriatrics
关键词
脑出血
降压
控制性
Cerebral hemorrhage
Hypotension controlled
