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目的探讨乌拉地尔强化降压治疗对高血压性脑出血患者血肿扩大的影响。方法将146例高血压性脑出血患者随机分为强化降压组(强化组,75例,微量泵静脉注射乌拉地尔,平均动脉压目标值为110 mmHg)和常规降压组(对照组,71例,口服卡托普利,平均动脉压目标值为130 mmHg)。观察治疗后两组血肿体积、血肿扩大率、美国国立卫生研究院卒中量表(NIHSS)评分,以及死亡率和药物不良反应的情况。结果治疗24 h后强化组血肿平均体积[(11.9±9.5)m l]、血肿扩大率(14.7%,11例)及NIHSS评分[(7.2±5.0)分]与对照组[(13.2±9.9)m l、(31.0%,22例)、(8.9±6.8)分]比较,差异有统计学意义(均P<0.05)。发病30 d后强化组NIHSS评分[(4.6±3.4)分]显著低于对照组[(5.7±4.1)分](P<0.01);死亡率(5.3%)较对照组(9.9%)下降,但差异无统计学意义;两组不良反应差异无统计学意义。结论乌拉地尔强化降压治疗可预防高血压性脑出血患者发生血肿扩大,并且安全可靠。
Objective To investigate the effect of intensive antihypertensive therapy of urapidil on hematoma enlargement in patients with hypertensive intracerebral hemorrhage. Methods One hundred and sixty-six patients with hypertensive intracerebral hemorrhage were randomly divided into intensive antihypertensive group (intensive group, 75 cases, intravenous injection of uracil by micro-pump, mean arterial pressure of 110 mmHg) and conventional antihypertensive group (control group, 71 cases, oral captopril, mean arterial pressure target value of 130 mmHg). The hematoma volume, hematoma expansion rate, NIHSS score, and mortality and adverse drug reactions were observed after treatment. Results The mean volume of hematoma (11.9 ± 9.5) ml, hematoma expansion rate (14.7%, 11 cases) and NIHSS score (7.2 ± 5.0) in the intensive therapy group were significantly higher than those in the control group [(13.2 ± 9.9) ml , (31.0%, 22 cases) and (8.9 ± 6.8) points respectively. The difference was statistically significant (all P <0.05). The NIHSS score of the intensive group was significantly lower than that of the control group (4.6 ± 3.4) 30 d after the onset of disease (P <0.01) (4.6 ± 3.4) (P <0.01) But the difference was not statistically significant; there was no significant difference between the two groups in adverse reactions. CONCLUSIONS: Urapidil-antihypertensive treatment can prevent hematoma enlargement in patients with hypertensive intracerebral hemorrhage and is safe and reliable.