论文部分内容阅读
目的 探讨脑出血急性期控制性强化降压的疗效.方法 88例脑出血急性期患者按随机数字表法分为控制性降压组(48例)和一般性降压组(40例),分别给予积极降压和按指南降压治疗,比较两组入院后颅内血肿体积、格拉斯哥昏迷量表(GCS)评分、美国国立卫生研究院卒中量表(NIHSS)评分及入院后24 h内手术率和入院后30 d内病死率的差异.结果 两组初始出血量比较差异无统计学意义(P＞0.05).控制性降压组入院后24h颅内血肿体积、颅内血肿增长率、颅内血肿增大比例均低于一般性降压组,差异有统计学意义[(19.3±11.6) ml比(30.5±10.9) ml,(17.8±12.7)％比(37.1±25.7)％,16.7％(8/48)比47.5％ (19/40)](P＜ 0.05或＜0.01).两组患者分别在入院时和入院后1,7,14d行GCS和NIHSS评分,各时间点组间比较差异均无统计学意义(P＞0.05).控制性降压组入院后24 h内手术率显著低于一般性降压组[8.3％(4/48)比25.0％(10/40)],差异有统计学意义(P＜0.01).两组入院后30 d内病死率比较差异无统计学意义(P＞0.05).结论 脑出血早期控制血压不能改变其近期神经功能恢复和降低病死率,但可以显著延缓血肿的扩大和减少手术率.“,”Objective To investigate the effect of controlled intensive blood pressure reduction on acute cerebral hemorrhage.Methods Eighty-eight patients with acute cerebral hemorrhage were divided into controlled blood pressure reduction group (controlled group,48 cases) and general blood pressure reduction group(general group,40 cases) by random number table method.Respectively given positive blood pressure reduction and according to the guidelines for treatment.The intracranial hematoma volume after admission,Glasgow coma scale (GCS) score,the United States national institutes of health stroke scale (NIHSS) score,surgery rate within 24 h after admission and fatality rate within 30 d after admission in two groups were compared.Results The initial blood loss between two groups had no significant difference(P ＞0.05).The intracranial hematoma volume,growth rate of intracranial hematoma,intracranial hematoma enlargement ratio in controlled group on 24 h after admission were lower than those in general group,there were significant differences [(19.3 ± 11.6) ml vs.(30.5 ± 10.9) ml,(17.8 ± 12.7)％ vs.(37.1 ±25.7)％,16.7％ (8/48) vs.47.5％ (19/40)] (P ＜ 0.05 or ＜ 0.01).The GCS and NIHSS score between two groups on admission and 1,7,14 d after admission had no significant difference(P ＞ 0.05).The surgery rate within 24 h after admission in controlled group was lower than that in general group [8.3％ (4/48) vs.25.0％ (10/40)],there was significant difference (P ＜ 0.01).The fatality rate within 30 d after admission between two groups had no significant difference (P ＞ 0.05).Conclusion Cerebral hemorrhage early control of blood pressure can not change its recent neural functional recovery and reduce the fatality rate,but may be significantly delayed hematoma enlargement and reduce the rate of surgery.