CAJ | 학술논문

目的探讨控制血压对超早期基底节区脑出血血肿扩大的防治作用和神经功能的影响.方法选择2009年11月至2011年11月在滨州市人民医院神经内科住院治疗的超早期基底节区脑出血患者共120例,随机分成强化降压组和普通降压组,每组各60例.强化降压组在开始治疗后的1h内首选静脉降压药物使收缩压控制在130～140 mm Hg,普通降压组收缩压控制在160～180 mm Hg,均持续24h.分别于治疗前及治疗后24h测定CT血肿体积,治疗前及治疗后24h和2周进行美国国立卫生研究院卒中量表(NIHSS)评分,所得数据进行统计学处理.结果强化降压组患者24h时的血肿体积(11.99±6.90) ml明显低于普通降压组(14.74±7.75) ml,差异有统计学意义(t=2.049,P=0.043)、血肿扩大例数明显少于普通降压组(5例和14例,x2=5.070,P=0.024)；强化降压组NIHSS评分治疗前(9.74±4.49)分与治疗后24 h(9.25 ±4.10)分比较,差异无统计学意义(P＞0.05)；强化降压组治疗前NIHSS评分(9.74±4.49)分与治疗后2周(6.28±3.68)分,组内比较差异有统计学意义(P＜0.05)；普通降压组[(9.50±4.81)分、(7.82±4.28)分]组内比较差异有统计学意义(P＜0.05)；两组治疗后2周的NIHSS评分组间比较差异有统计学意义[(6.28±3.68)分与(7.82±4.28)分,P＜0.05].结论基底节区脑出血患者超早期强化降压治疗安全,能减少血肿扩大的发生,改善患者的早期神经功能.
목적 탐토공제혈압대초조기기저절구뇌출혈혈종확대적방치작용화신경공능적영향.방법 선택2009년11월지2011년11월재빈주시인민의원신경내과주원치료적초조기기저절구뇌출혈환자공120례,수궤분성강화강압조화보통강압조,매조각60례.강화강압조재개시치료후적1h내수선정맥강압약물사수축압공제재130～140 mm Hg,보통강압조수축압공제재160～180 mm Hg,균지속24h.분별우치료전급치료후24h측정CT혈종체적,치료전급치료후24h화2주진행미국국립위생연구원졸중량표(NIHSS)평분,소득수거진행통계학처리.결과 강화강압조환자24h시적혈종체적(11.99±6.90) ml명현저우보통강압조(14.74±7.75) ml,차이유통계학의의(t=2.049,P=0.043)、혈종확대례수명현소우보통강압조(5례화14례,x2=5.070,P=0.024)；강화강압조NIHSS평분치료전(9.74±4.49)분여치료후24 h(9.25 ±4.10)분비교,차이무통계학의의(P＞0.05)；강화강압조치료전NIHSS평분(9.74±4.49)분여치료후2주(6.28±3.68)분,조내비교차이유통계학의의(P＜0.05)；보통강압조[(9.50±4.81)분、(7.82±4.28)분]조내비교차이유통계학의의(P＜0.05)；량조치료후2주적NIHSS평분조간비교차이유통계학의의[(6.28±3.68)분여(7.82±4.28)분,P＜0.05].결론 기저절구뇌출혈환자초조기강화강압치료안전,능감소혈종확대적발생,개선환자적조기신경공능.
Objective To study the preventive and therapeutic effects of blood pressure control on hematoma expansion and neurological function in patients with ultra-early basal ganglia intracerebral hemorrhage.Methods From November 2009 to November 2011,120 patients with ultra-early basal ganglia intracerebral hemorrhage from our Hospital were enrolled and randomly divided into intensive blood pressure reduction group and general blood pressure reduction group in equal numbers (n =60).The antihypertensive agent were used intravenously to reduce the systolic blood pressure by 130-140 mm Hg within l hour after treatment in patients of intensive blood pressure reduction group; and the general blood pressure reduction group was control by 160-180 mm Hg.The blood pressure of patients in both groups was maintained for 24 hours.The volume of haematoma in CT was measured before and 24 hours after treatment.The National Institutes of Health Stroke Scale (NIHSS) score was assessed 24 hours before and after treatmentand 14 days after treatment respectively.Statistical analyses were conducted.Results Between 24 hours before and after treatment,therewere significant difference in the hematoma volume((11.99 ± 6.90) ml vs.(14.74 ± 7.75) ml,t =2.049,P =0.043) and the number of cases of hematoma enlargement(5 vs.14,x2 =5.07,P =0.024) between the two groups.Between 24 hours before and after treatment,there was no significant difference in NIHSS scale in intensive blood pressure reduction group ((9.74 ± 4.49) vs.(9.25 ± 4.10),P ＞ 0.05).Between 24 hours before and 2 weeks after treatment,there were significant difference in NIHSS scale in both groups ((9.74 ± 4.49) vs.(6.28 ± 3.68),P ＜ 0.05 ; (9.50 ± 4.81) vs.(7.82 ± 4.28),P ＜ 0.05,respectively).At two weeks after treatment,there was significant difference in NIHSS scale between two groups ((6.28 ± 3.68) vs.(7.82 ± 4.28),P ＜ 0.05).Conclusion Intensive reduction of blood pressure is safe for the treatment of ultra-early basal ganglia intracerebral hemorrhage and reduce the incidence of hematoma enlargement and improve patient's early neurological function.