积极降压在老年急性脑出血治疗中的应用

目的 探讨积极降压在老年急性脑出血治疗中的应用价值.方法 采用随机对照研究设计,选择2006年1月至2007年12月在大津医科大学总医院住院的老年急性期脑出血患者共40例,随机分成积极降压组和对照组,每组各20例.积极降压组在开始治疗后的l h内首选静脉降压药物使收缩压<140 mmHg,并维持7 d;对照组早期控制收缩压<180 mmHg.分别于治疗前及治疗后3 d测定CT血肿体积,治疗前及治疗后7 d和28 d进行美国国立卫生研究院卒中量表(NHIss)评分,治疗后90 d进行Rankin最表(mRS)评分.所得结果应用SPSS 16.0软件进行统计学处理,计量资料采用成组t检验和配对t检验,计数资料采用χ~2检验,P<0.05为差异具有统计学意义.结果 积极降压组患者3 d时血肿体积增加绝对值明显少于对照组(P<0.05);积极降压组治疗前和治疗后7 d的NHISS评分间差异具有统计学意义(P<0.05),而对照组治疗前和治疗后7 d的NHISS评分间差异无统计学意义(P>0.05);两组治疗前和治疗后28 d的NHISS评分差值间的差异有统计学意义(P<0.05);两组治疗后90 d轻度以下残疾及中重度残疾患者例数间的差异具有统计学意义(P<0.05).结论 积极降压对老年急性期脑出血有较好的治疗作用.

Intensive reduction of blood pressure for the treatment of acute cerebral hemorrhage in elderly patients

Objective To study the application of intensive reduction of blood pressure to the treatment of acute cerebral hemorrhage in elderly patients. Method From January 2006 to December 2007, 40 elderly patients with acute cerebral hemorrhage were enrolled in a randomized and controlled study. Patients were randomly divided into intensive blood pressure reduction group and control group in equal number ( n = 20). The antihyper-tensive agent was used intravenously to reduce the systolic blood pressure to the level lower than 140 mmHg within 1 hour after treatment in patients of intensive blood pressure reduction group, and then the blood pressures was maintained for 7 days.The blood pressure of patients in control group was reduced to that just under 180 mmHg. The size of the haematoma was measured before and 3 days after treatment. The Stroke Scale set by the American National Institutes of Health (NHISS) was assessed before and 7 days and 28 days after treatment,separately. The modified Rankin Scale (mRS) was used to assess the patients 90 days after treatment. The outcomes were statistically analyzed with SPSS version 16.0 software. Measurement data were analyzed with t -test while numeration data were analyzed with chi-square test. Results Before and 3 days after treatment, there was significant difference in size hematoma between two groups (P < 0.05) . Between before and 7 days after treatment, there was significant difference in NHISS scale in intensive blood pressure reduction group (P < 0.05), but there was no significant difference in control group (P > 0.05). Before and 28 days after treatment, there was significant difference in variance of NHISS scale between two groups ( P < 0.05) . Nineth days after treatment, there was significant difference in mild disability and severe disability between two groups ( P < 0.05) . Conclusions Intensive reduction of blood pressure is valid for the treatment of elderly patients with acute cerebral hemorrhage.