急诊干预对防止脑出血后早期血肿扩大的临床意义

目的通过对高血压性脑出血患者急诊干预方法以及脑出血后血肿变化的总结,探讨急诊干预对防止高血压性脑出血后早期血肿扩大的临床意义。方法对2008年6月—2012年12月因高血压性脑出血来深圳龙华医院急诊患者的临床资料进行回顾性分析,在所有资料中随机抽取实施急诊规范化干预的患者90例（干预组）及未实施急诊规范化干预患者90例（对照组）,对2组患者的年龄、性别、早期血肿扩大率进行比较。急诊干预措施包括患者呼吸道的管理、血压的调节、颅内压检测、静脉输入止血药物、确保患者处于安静状态、留着尿管、完善必要的常规检查等,其中血压的调节笔者采用的是乌拉地尔静脉注射加静脉输入的方法对患者进行早期强化降压治疗。对高血压脑出血伴血压升高的患者,在接诊后1 h内将患者的收缩压降至130～140 mm Hg,且一直维持此水平,保持血压的稳定,防止血压的波动。结果 2组患者在年龄及性别方面差异无统计学意义（P〉0.05）,干预组患者脑出血后早期血肿扩大率明显低于对照组,差异有统计学意义（χ^2=9.13,P〈0.01）。结论高血压脑出血发病急,病情危重且变化快,对高血压性脑出血患者进行急诊规范化的干预有助于血肿的稳定,对防止脑出血后早期血肿进一步扩大及提高患者的生存率及生存质量有着积极的临床意义。在临床工作中应将急救服务体系即院前急救体系、院内急救体系和重症监护治疗体系切实落实到脑出血整个治疗过程中。

The clinical significance of emergency intervention in prevention of early hematoma enlargement after cerebral hemorrhage

Objective Through emergency intervention in patients with hypertensive cerebral hemorrhage and the change of cerebral hemorrhage haematoma,to explore the emergency intervention on the prevention and treatment of hypertensive cerebral hemorrhage hematoma enlargement after clinical significance. Methods From June 2008 to December 2012,the clinical data of patients with hypertensive cerebral hemorrhage in our hospital emergency were analyzed retrospectively,all the information was randomly selected to implement standardization of emergency intervention（intervention group） and 90 cases of patients without implementing standardization of emergency intervention patients 90 cases（control group）,the two groups of patient＇s age,gender and hematoma enlargement rate were compared. Emergency interventions including the management of patients with respiratory tract,the regulation of blood pressure,intracranial pressure test,intravenous input hemostatic drugs,to ensure that the patient was in a state of quiet,keep the urine tube,improve the necessary routine inspection,etc.,in which we adopt the regulation of blood pressure,intravenous ulla vein input method for patients with early intensive treatment. For patients with hypertension cerebral hemorrhage associated with high blood pressure,in accept within 1 hour after the patient＇s systolic blood pressure dropped to 130- 140 mm Hg,and maintained the level,maintained the stability of blood pressure,controlled blood pressure fluctuations. Results Between the two groups of patients,there was no statistically significant difference in age and gender（ P〉0. 05）,intervention group patients after cerebral hemorrhage hematoma enlargement rate was significantly lower than the control group,with significant difference statistically significant（χ^2= 9. 13,P〈0. 01）. Conclusion Hypertension cerebral hemorrhage disease nasty,in a critical condition and fast change,standardization of emergency intervention in patients with hypertensive cerebral hemorrhage was helpful t