Résumé
Objective To study the preventive and therapeutic effects of blood pressure control on hematoma expansion and neurological function in patients with ultra-early basal ganglia intracerebral hemorrhage.Methods From November 2009 to November 2011,120 patients with ultra-early basal ganglia intracerebral hemorrhage from our Hospital were enrolled and randomly divided into intensive blood pressure reduction group and general blood pressure reduction group in equal numbers (n =60).The antihypertensive agent were used intravenously to reduce the systolic blood pressure by 130-140 mm Hg within l hour after treatment in patients of intensive blood pressure reduction group; and the general blood pressure reduction group was control by 160-180 mm Hg.The blood pressure of patients in both groups was maintained for 24 hours.The volume of haematoma in CT was measured before and 24 hours after treatment.The National Institutes of Health Stroke Scale (NIHSS) score was assessed 24 hours before and after treatmentand 14 days after treatment respectively.Statistical analyses were conducted.Results Between 24 hours before and after treatment,therewere significant difference in the hematoma volume((11.99 ± 6.90) ml vs.(14.74 ± 7.75) ml,t =2.049,P =0.043) and the number of cases of hematoma enlargement(5 vs.14,x2 =5.07,P =0.024) between the two groups.Between 24 hours before and after treatment,there was no significant difference in NIHSS scale in intensive blood pressure reduction group ((9.74 ± 4.49) vs.(9.25 ± 4.10),P ＞ 0.05).Between 24 hours before and 2 weeks after treatment,there were significant difference in NIHSS scale in both groups ((9.74 ± 4.49) vs.(6.28 ± 3.68),P ＜ 0.05 ; (9.50 ± 4.81) vs.(7.82 ± 4.28),P ＜ 0.05,respectively).At two weeks after treatment,there was significant difference in NIHSS scale between two groups ((6.28 ± 3.68) vs.(7.82 ± 4.28),P ＜ 0.05).Conclusion Intensive reduction of blood pressure is safe for the treatment of ultra-early basal ganglia intracerebral hemorrhage and reduce the incidence of hematoma enlargement and improve patient's early neurological function.
Résumé
Objective To study the safety and efficacy of intensive reduction of blood pressure for the treatment of acute cerebral haemorrhage. Method A randomized control trial in 41 consecutive patients with intracerebral haemorrhage admitted from October 2006 to January 2007 were randomly assigned to intensive blood pressure reduction group ( n = 24) or guidelines blood pressure reduction group ( n = 17) (tho guidelines set by American Association of cardiologists). In the intensive reduction group, the systolic pressure was reduced immediately to lower than 140 mmHg, while the blood pressure was reduced to that just below 180 mmHg in guideline reduction group. The size of the haematoma was measured 24 h after treatment by CT scans and the patients were followed up for 90 days. Death and/or disability in 90 days, and the short-term and long-term neurological function and the size of haematoma in 24 hours of two groups were compared. The outcomes were statistically analyzed with SPSS version 10.0 software. Measurement data were analyzed with t -test while numeration data were analyzed with chisquare test. Results There were no significant differences either in death and/or disability or in short-term and long-term neurological function in 90 days after treatment ( P ＞ 0.05). The mean values of proportional enlargement of haematoma were 16.8% in the intensive group and 36. 1% in the guidelines group 24 hours after treatment ( P = 0.012). The mean values of absolute enlargement of haematoma of two groups were 2.7 mL and 5. 1 mL,respectively (P = 0.058). There was significant difference in rate of enlargement of haematoma in the early stage of acute cerebral haemorrhage (4.2% vs. 47. 1%, P = 0.012). Conclusions Although intensive reduction of blood pressure in patients with acute cerebral haemorrhage did not alter the clinical prognosis of patients, it could apparently attenuate the enlargement of haematoma in the early stage of acute cerebral haemorrhage.
Résumé
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.