早期强化降压与标准降压治疗对高血压脑出血老年患者功能改善及预后的影响比较

Effect of early intensive antihypertensive therapy versus standard guideline antihypertensive therapy on functional improvement and prognosis of elderly patients with hypertensive intracerebral hemorrhage

摘要:

目的 探讨早期强化降压与标准降压治疗对高血压脑出血老年患者术后功能改善及预后的影响。方法 选取四川省巴中市中心医院南坝分院高血压脑出血老年患者200例（2016年3月-2019年1月），按照随机数字表法分为强化降压组（n=100）与标准降压组（n=100）。强化降压组在常规干预基础上采取强化降压治疗，标准降压组采取指南标准降压治疗。统计两组治疗前及治疗后第1、7及14天时神经功能（NIHSS）、血肿体积与血肿扩大率、核因子κβ（NF-κβ）、血管性血友病因子（vWF）、肿瘤坏死因子-α（TNF-α）、基质金属蛋白酶-9（MMP-9）值，治疗后3个月随访统计预后效果。结果 ①神经功能：不同时间点间的神经功能评分有差别（P<0.05），组间的神经功能评分有差别（P<0.05），强化降压组与标准降压组的神经功能评分变化趋势有差别（P<0.05）；②血肿体积与血肿扩大率：治疗后第1天两组血肿体积较治疗前增加，但强化降压组小于标准降压组，强化降压组的第7天血肿清除率（91.00%）高于标准降压组（74.00%），差异有统计学意义（P<0.05）；③NF-κβ、vWF、TNF-α及MMP-9水平：不同时间点间的NF-κβ、vWF、TNF-α及MMP-9水平有差别（P<0.05），组间的NF-κβ、vWF、TNF-α及MMP-9水平有差别（P<0.05），强化降压组与标准降压组的NF-κβ、vWF、TNF-α及MMP-9水平变化趋势有差别（P<0.05）；④预后效果：强化降压组预后效果优于标准降压组，预后良好率（60.00%）高于标准降压组（38.00%），差异有统计学意义（P<0.05）。结论 采取早期强化降压治疗高血压脑出血效果优于指南标准降压，可有效改善患者神经功能，抑制血肿扩大，调节血清NF-κβ、vWF等指标水平，利于改善预后效果。

Abstract:

Objective To investigate the effect of early intensive antihypertensive therapy versus standard guideline antihypertensive therapy on functional improvement and prognosis of elderly patients with hypertensive intracerebral hemorrhage (HICH).Methods A total of 200 elderly patients with HICH who were treated in Nanba Branch of Bazhong Central Hospital from March 2016 to January 2019 were enrolled and divided into intensive antihypertensive therapy group and standard antihypertensive therapy group using a random number table, with 100 patients in each group. On the basis of routine intervention, the patients in the intensive antihypertensive therapy group were given intensive antihypertensive therapy, and those in the standard antihypertensive therapy group were given standard antihypertensive therapy. Related indices were measured before treatment and on days 1, 7, and 14 after treatment, i.e., neurological score (National Institute of Health Stroke Scale), hematoma volume and hematoma enlargement rate, nuclear factor-κβ (NF-κβ), von Willebrand factor (vWF), tumor necrosis factor-α (TNF-α), and matrix metalloproteinase-9 (MMP-9), and prognosis was evaluated during the 3-month follow-up after treatment.Results As for neurological function, there was a significant difference in neurological score between different time points (P<0.05), and there were significant differences in neurological score and its changing trend between the intensive antihypertensive therapy group and the standard antihypertensive therapy group (P<0.05). As for hematoma volume and hematoma enlargement rate, both groups had an increase in hematoma volume on day 1 after treatment, while the intensive antihypertensive therapy group had a lower volume than the standard antihypertensive therapy group, and on day 7, the intensive antihypertensive therapy group had a significantly higher hematoma enlargement rate than the standard antihypertensive therapy group (91.00% vs 74.00%, P<0.05). There were significant differences in the levels of NF-κβ, vWF, TNF-α, and MMP-9 between different time points (P<0.05) and between the intensive antihypertensive therapy group and the standard antihypertensive therapy group (P<0.05), and there were also significant differences in the changing trends of NF-κβ, vWF, TNF-α, and MMP-9 between the two groups (P<0.05). Compared with the standard antihypertensive therapy group, the intensive antihypertensive therapy group had a better prognostic effect and a significantly higher good prognosis rate (60.00% vs 38.00%, P<0.05).Conclusions Compared with standard antihypertensive therapy, early intensive antihypertensive therapy has a better effect on the treatment of HICH and can effectively improve patients' neurological function, inhibit the enlargement of hematoma, regulate the serum levels of the indices including NF-κβ and vWF, and improve prognosis.