不同血压控制对高血压脑出血患者局部脑血流量及预后的影响

目的　探讨不同程度和时间控制血压对高血压脑出血患者局部脑血流量 (rCBF)及血肿扩大 (HD)或再出血 (HR)的影响。方法　 115例高血压脑出血患者经头部CT确诊后 ,测得最初血压 ,依不同情况的血压控制分为A、B、C三组 ,并分别入院 3d内、 15～ 2 5d和 3d内、 10～ 15、 2 0～ 2 5行单光子发射计算机断层显像 (SPECT)检查和神经功能评定 ,图像处理和评分采用盲法。结果　 (1)发病时 (3d内 ) ,平均动脉压降低大于 2 0 %组 (A组 )其rCBF下降较降压在 5 %～ 2 0 %组 (B组 )和降压小于 5 %组 (C组 )差异有显著性 (P <0 0 5 ,P <0 0 1) ;慢性期 (15～ 2 5d) ,则三组差异无显著性 (P >0 0 5 )。 (2 )C组发生HD或HR的机会明显大于A、B组 (P <0 0 5 )。 (3)A组神经功能下降在各期均较B组和C组明显(P <0 0 5 ,P <0 0 1)。结论　对高血压脑出血患者急性期平均动脉压降低在 5 %～ 2 0 % ,则既不加剧rCBF下降和继发神经功能损害 ,也不增加HD或HR的机会

The effect of different blood pressure control on regional cerebral blood flow and prognosis in patients with hypertensive intracerebral hemorrhage

Objective To explore the effect on regional cerebral blood flow(rCBF),cerebral hematoma development(HD),and or rebleeding(HR)by controlling blood pressure in different degree and duration in patients with hypertensive intracerebral hemorrhage(HICH).Methods 115 patients with hypertensive intracerebral hemorrhage were diagnosed by CT and divided into group A,B and C.Blood pressure was measured.SPECT and clinical neurological function were assessed in patients 3 days,15 25 days and 3 days,10 15 days,20 25 days,respectively,after admission.Results (1)within 3 days after onset,there was a significant difference in rCBF decrease in patients with mean arterial blood pressure(MABP)between group A and group B,group C ( P <0 05, P <0 01).In 15 25 days,there were no significant differences in three groups( P >0 05).(2)The occurrence rate for HD or HR in group C was higher than that in other groups.(3)The neurological function in group A was significantly reduced.Conclusion For patients in acute phase after hypertensive intracerebral hemorrhage,the best range of MABP reduction is 5% 20%.In this case,there can neither be an increase of rCBF and neurological function impairment nor increasie in the risk for HD and HR.