摘要
背景高血压脑出血合并脑疝患者常预后极差,有研究显示术前强化降压管理能够改善患者预后,但目前对于术前强化降压的目标血压尚存争议。目的探讨术前不同血压管理目标对高血压脑出血合并脑疝患者预后的影响及其预后影响因素。方法采用前瞻性队列研究的方法,选取2016年10月—2019年10月在重庆市璧山区人民医院治疗的高血压脑出血合并脑疝患者80例为研究对象,按照随机数字表法分为A组(40例)和B组(40例)。其中A组术前收缩压控制目标为120~140 mm Hg(1 mm Hg=0.133 kPa),B组术前收缩压控制目标为141~160 mm Hg,两组术后收缩压控制目标均为120~140 mm Hg。比较两组主要终点指标〔治疗30 d后格拉斯哥结局量表(GOS)评分〕、次要终点指标〔术前及术后第1、3、5、7、9天超敏C反应蛋白(hs-CRP)水平,不良事件(包括严重低血压、缺血性脑卒中、心血管事件、脑出血面积扩大)发生情况〕。高血压脑出血合并脑疝患者预后的影响因素分析采用单因素及多因素Logistic回归分析。结果A组最终完成研究39例,B组最终完成研究38例。两组治疗30 d后GOS评分比较,差异无统计学意义(P>0.05)。干预方法与时间在hs-CRP水平上不存在交互作用(P>0.05);干预方法在hs-CRP水平上主效应不显著(P>0.05);时间在hs-CRP水平上主效应显著(P<0.05)。B组术前、术后第1天hs-CRP水平高于A组(P<0.05)。A组、B组术后第1天hs-CRP水平分别高于本组术前,术后第3、5、7、9天hs-CRP水平分别低于本组术前(P<0.05);A组、B组术后第3、5、7、9天hs-CRP水平分别低于本组术后第1天(P<0.05);A组、B组术后第5、7、9天hs-CRP水平分别低于本组术后第3天(P<0.05);A组、B组术后第7、9天hs-CRP水平分别低于本组术后第5天(P<0.05);A组、B组术后第9天hs-CRP水平分别低于本组术后第7天(P<0.05)。两组严重低血压、缺血性脑卒中、心血管事件、脑出血面积扩大发生�
Background The patients who have hypertensive intracerebral hemorrhage and cerebral hernia often have a very poor prognosis.Studies have shown that intensive blood pressure management before operation can improve the prognosis of patients.However,there is still controversy about the target blood pressure level of preoperative intensive blood pressure reduction.Objective To investigate the impact and influencing factors of different preoperative blood pressure management target on the prognosis of patients with hypertensive intracerebral hemorrhage and cerebral hernia.Methods Using a prospective cohort study method,80 patients with hypertensive cerebral hemorrhage and cerebral hernia who were treated at Bishan People's Hospital of Chongqing from October 2016 to October 2019 were selected as the research objects,and they were divided into group A(40 cases)and group B(40 cases)according to the random number table method.The preoperative systolic blood pressure control target of group A was 120-140 mm Hg(1 mm Hg=0.133 kPa),the preoperative systolic blood pressure control target of group B was 141-160 mm Hg,and the postoperative systolic blood pressure control target of the two groups was 120-140 mm Hg.The primary endpoint indicators(GOS score after 30 days of treatment),secondary endpoint indicators(hs-CRP) levels before operation and on the first,third,fifth,seventh and ninth days after operation,and occurrence of adverse events related to blood pressure management(including severe hypotension,ischemic stroke,cardiovascular events,and enlargement of cerebral hemorrhage)were compared between the two groups.Univariate and multivariate Logistic regression analysis was used to analyze the prognostic factors of patients with hypertensive intracerebral hemorrhage and cerebral hernia.Results Finally,39 patients in group A completed the study,and 38 patients in group B finally completed the study.There was no significant difference in GOS score between the two groups after 30 days of treatment(P>0.05).There was no interacti
作者
牟科杰
阴金波
薛军
MOU Kejie;YIN Jinbo;XUE Jun(Department of Neurosurgery,Bishan People's Hospital of Chongqing,Chongqing 402760,China;Department of Neurosurgery,Xinqiao Hospital Affiliated to Military Medical University of the Army,Chongqing 400037,China)
出处
《实用心脑肺血管病杂志》
2020年第12期34-39,共6页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
重庆市卫生计生委医学科研计划面上项目(2016MSXM178)。
关键词
颅内出血
高血压性
脑膨出
血压管理
预后
影响因素分析
Intracranial hemorrhage,hypertensive
Encephalocele
Blood pressure management
Prognosis
Root cause analysis
