腦出血超早期強化降壓對患者血腫擴大及神經功能的影響

[摘要] 目的 探討腦出血4 h內強化降壓對基底節區腦出血血腫擴大、血腫周圍腦組織水腫、早期神經功能及治療后90 d生活自理能力的影響。 方法 整群選取2014年3月—2016年2月發病4 h內的腦出血患者143例，隨機分為觀察組72例和對照組71例，觀察組患者在發病1 h內將收縮壓控制在130～140 mmHg，對照組患者在發病1 h內將收縮壓控制在160～180 mmHg，分別于治療前、治療后24 h、治療后5 d時查頭顱CT，計算治療24 h后兩組患者腦出血血腫量及治療5 d后兩組患者腦組織水腫量，評價兩組患者治療前、治療后24 h、治療后14 d神經功能缺損（NIHSS）評分，隨訪兩組患者治療后3個月時改良Rankin量表（mRS）評分，評價兩組患者的生活自理能力。 結果 強化降壓治療后24 h觀察組患者血腫量明顯低于對照組[（12.2±4.7）vs（14.7±4.9）]mL（P<0.05），治療5 d后觀察組患者腦組織水腫量明顯小于對照組[（5.0±1.5）vs（7.3±2.1）]mL（P<0.05），治療后24 h觀察組患者NIHSS評分中位數與對照組比較[10.0（8.0，12.8）vs10.5（8.0，14.0）]差異無統計學意義（P>0.05），治療后14 g觀察組患者NIHSS評分中位數明顯低于對照組[5.5（3.0，10.0）vs8.0（5.0，12.0）]（P<0.05），治療后3個月觀察組患者mRS評分為3～6分的比例顯著低于對照組（22.2%vs39.4%）（P<0.05）。結論 腦出血4 h內強化降壓治療可緩解基底節區腦出血患者24 h內血腫擴大，減輕患者發病5 d內血腫周圍腦組織水腫，改善患者早期神經功能及治療后3個月生活自理能力。

[關鍵詞] 早期；強化降壓；血腫量；腦組織水腫；神經功能；生活自理能力

[中圖分類號] R743.34 [文獻標識碼] A [文章編號] 1674-0742（2016）11（a）-0020-04

[Abstract] Objective To investigate the effect of enhanced depressurization within 4 hours on hematoma enlargement of intracerebral hemorrhage in basal ganglia region， edema of brain tissue around hematoma， early neurological function and self-care ability 90 days after treatment. Methods Group selection 143 patients from March 2014 to February 2016 within 4 h of onset of cerebral hemorrhage were randomly divided into observation group 72 cases and control group 71 cases， observation group patients at the onset of 1H in systolic blood pressure in 130～140mmHg patients in the control group within 1 h systolic blood pressure in the treatment of 160～180mmHg， respectively， before treatment， treatment after 24 h， 5 d after check head CT， two groups of patients with cerebral edema volume of hematoma volume and 5 d after treatment in two groups of patients with cerebral hemorrhage is calculated after 24 h treatment， evaluation of two groups of patients before and after treatment， 24 h， 14 d after treatment of neural function defect score（NIHSS）， the two groups after 3 months treatment when the modified Rankin scale（mRS） score， evaluation of two groups of patients with self-care ability. Results Hematoma volume was less in treatment group than control group 24 hours after enhanced depressurization[（12.2±4.7）vs（14.7±4.9）]mL（P<0.05）， and brain edema was less severe in treatment group than control group 5 days after intervention[（5.0±1.5）vs（7.3±2.1）]mL（P<0.05）. There is no difference between the two groups on NIHSS score 24 hours after treatment， whereas， NIHSS is obviously lower in treatment group than control group 14 days after intervene. The proportion of mRS score from 3 to 6 is lower in treatment group than control group 3 months after treatment（22.2%vs39.4%）（P<0.05）. Conclusion Enhanced depressurization of patients suffering from intracerebral hemorrhage within 4 hours can decrease the enlargement of hematoma volume in basal ganglia region in 24 hours， attenuate brain edema 5 days after onset and improve neurological function in early stage and self-care ability 3 months after treatment.

[Key words] Enhanced depressurization； Hematoma； Edema of brain tissue； Neurological function；Self-care ability

腦出血是神經外科常見急癥，致死致殘率較高，嚴重威脅著患者的健康和生活。腦出血后病理生理過程主要包括血腫形成、血腫擴大和血腫周圍組織水腫三個階段，血腫擴大與早期神經功能惡化密切相關[1]，也決定患者預后。……