脑出血急性期降压策略对早期血肿增大及临床转归的影响

目的评价脑出急性期不同降压策略的安全性和有效性。方法前瞻性将41例连续入院且发病存6h内的自发性脑出血患者随机分为两组，积极降压组（入院即开始降压治疗，目标收缩胝≤140mmHg）24例，指南降压组（根据美围心脏协会2007年指南，收缩压≥180mmHg才开始降压治疗）17例。24h后复查头部CT并随访至90d，记录和比较分析两组患者24h的血肿增大状况、90d死亡／残疾率及不良事件。结果采取降压措施后两组平均收缩压较人院时均有所下降，在随机分组后1、24h时间点上，两组收缩压差异均有统计学意义（均P〈0．05）。①积极降压组与指南降压组24hm肿增加中位数分别为1．64ml（-1．02～13．03）和3．52ml（0．57～18．26），差异有统计学意义（P：0．025）；24h平均血肿增长率，积极降压组中位数为16％（-5％～63％），指南降压组为29％（3％～100％），两组比较差异有统计学意义（P=0．011）；两组发生早期血肿扩大的发生率分别为4．17％和47．06％，差异有统计学意义（P=0．004）。②两组90d死亡／残疾率、小良事件发生率差异无统计学意义（P〉0．05）。结论对脑出血患者，早期将收缩压降至≤140mmHg，显著减缓了24h内血肿的增大，但对90d的预后无显著影响。

Effect of blood pressure lowering strategy on the enlargement of hematoma and clinical outcome in patients with acute intracerebral haemorrhage

Objective To evaluate the safety and efficacy of blood pressure （BP） lowering strategies in patients with acute intracerebral hemorrhage. Methods Forty-one consecutive patients with spontaneous intracerebral hemorrhage admitted in hospital within 6 hours after onset of the symptom were randomly assigned into 2 groups ：the intensive BP-lowering group （ n = 24 ; antihypertensive treatment started immediately after admission, the target systolic blood pressure ≤ 140 mm Hg） and the guideline BP-lowering group （n = 17; when the systolic blood pressure ≥ 180 mm Hg, antihypertensive therapy begins according to the American Heart Association 2007 guidelines）. The CT scan was repeated after 24 hours and the patients were followed up for 90 days. The course of disease, the status of hematoma enlargement at 24 hour, the death/disability rate and adverse events at day 90 in the two groups were recorded and comparatively analyzed. Results After the blood lowering measures were taking, the mean systolic blood pressure of both groups was slightly lowered than that at admission. There were significant differences in systolic blood pressure at the different time points in the subsequent 1 to 24 hours between the two groups （ all P 〈 0. 05 ）. （1）The median enlargement of hematoma at 24 hours in the intensive BP-lowering and guideline BP- lowering groups were 1.64 ml（ - 1.02 - 13.03） and 3.52 ml（0.57 - 18.26） , respectively. There was significant difference between the two groups （ P = 0. 025 ）. The mean hematoma enlargement rate at 24 hours was 16% （ - 5% - 63% ） in the intensive BP - lowering group and 29% （3% - 100% ） in the guideline BP- lowering group. There was significant difference between the two groups （P = 0.011 ）. The incidence of early hematoma enlargement in both groups was 4.17% and 47.06% respectively. There was significant difference （P = 0. 004）. （2）There were no significant differences in the death/disability and the incidence of adverse events at day 90 between the two groups （ P 〉 0.05 ）. Conclusion The systolic blood pressure reduced to ≤ 140 mm Hg in patients with early intracerebral hemorrhage may slowdown the hematoma enlargement within 24 hours, but it does not have significant effect on the prognosis at day 90.