脑出血患者基础血压水平及不同血压控制策略与其临床预后的研究

目的 探讨脑出血患者基础血压水平与预后的关系以及不同的血压控制策略对血肿扩大和再出血的影响.方法 采用分组对照研究方法,将2010年1月至2013年1月收治的46例脑出血患者根据其入院第1天的基础血压（收缩压）水平分为A组（＜ 180 mmHg,1 mmHg=0.133 kPa）7例、B组（180 ～ 200 mmHg）6例以及C组（＞200 mmHg）33例;同时根据不同的血压控制策略分为E组（平均动脉压下降≥20％）31例和F组（平均动脉压下降＜20％）15例.分析并比较各组患者的预后情况.结果 C组患者6个月致死/致残率显著高于A组和B组21.2％（7/33）比1/7,1/6],差异有统计学意义（P＜0.05）.A组和B组患者比较差异无统计学意义（P＞0.05）.E组患者出现血肿扩大1例;F组患者出现血肿扩大4例,再出血1例,E组不良事件发生率明显低于F组3.2％（1/31）比5/15],差异有统计学意义（x2=5.642,P=0.018）.结论 患者发病初期的收缩压过高（＞ 200 mmHg）是影响预后的独立危险因素;而早期积极地降压能有效减少血肿扩大和再出血的发生.

Clinical study of basal blood pressure levels and different blood pressure control strategies with prognosis in patients with hemorrhage

Objecitve To explore the relationship between basal blood pressure levels and prognosis in patients with hemorrhage,and the influence of different blood pressure control strategies in hematoma expansion and bleeding again.Methods Research methods for group-control,46 patients with hemorrhage from January 2010 to January 2013 according to the basal blood pressure levels （systolic blood pressure） in the first day of admission were divided into group A （〈 180 mmHg,1 mmHg =0.133 kPa） 7 cases,group B （180-200 mmHg） 6 cases and group C （〉200 mmHg） 33 cases.At the same time according to different blood pressure control strategies were divided into group E （mean arterial pressure decreased ≥ 20%） 31 cases and group F （mean arterial pressure decreased 〈 20%） 15 cases,the prognosis among different groups was analyzed.Results The 6 months death / disability rate in group C was higher than that in group A and group B 21.2% （7/33） vs.1/7,1/6],there was significant difference （P 〈 0.05）.There was no significant difference between group A and group B（P〉 0.05）.Group E patients occurred with hematoma expansion in 1 case,group F occurred with hematoma expansion in 4 cases,and bleeding again in 1 case,incidence of adverse events in group E was lower than that in group F 3.2% （1/31） vs.5/15],there was significant difference （x2 =5.642,P =0.018）.Conclusion Early onset of high blood pressure （〉 200 mmHg） is the independent risk factor of prognosis,and early actively antihypertensive can effectively reduce the occurrence of hematoma expansion and bleeding again.