The Effect And Its Influential Factors Of Intensive Blood Pressure Reduction In The Prognosis Of Patients With Acute Cerebral Hemorrhage

Objective: To explore the effect of intensive blood pressure reduction in the prognosis of patients with acute cerebral hemorrhage,clearing influential factors of the prognosis. Methods: From October 2008 to February 2011, forward into the First Affiliated Hospital of Baotou Medical College Department of Neurology, patients with cerebral hemorrhage in hospital, requiring patients to complete the CT scan, to meet the entry criteria, received informed consent, baseline evaluation. Into the group in determining the conditions found in patients, randomized research program on blood pressure according to a corresponding treatment. Assigned to the positive step-down group of patients randomized within 1 hour in the systolic blood pressure to 140mmHg or less, and in the subsequent 7 days to maintain the target blood pressure. Assigned to the conservative treatment group, patients whose blood pressure treatment in accordance with AHA guidelines (see Table 1). In 28 days, 90 days of the patients were blinded follow-up, clear the degree of blood pressure control in patients after discharge, whether the blood pressure medication, and prognosis change. Results: (1) baseline data in the two groups were age, gender, past medical history aspect ratio similar to comparable. Two groups of patients on admission and severity of complications after hospital pretty much the same in both groups no significant differences (P> 0.05). (2) when two groups of 24±3h hematoma volume growth of value comparison, the active volume of hematoma in patient blood pressure increase (3.9±2.3ml) of less than conservative treatment group (8.5±5.4ml), early and aggressive antihypertensive treatment can reduce the average hematoma volume 4.6ml, hematoma volume growth in the value of the two groups had statistical difference (P <0.05). (3) 24h after the onset of the two groups when the blood pressure in patients with different degrees of blood pressure is higher than a positive step-down group of patients with conservative treatment, actively step-down group than in the conservative treatment group, the average blood pressure ranges from 10.2mmHg, 24h two down when There were significant differences in pressure levels (P <0.05). (4) The ratio of the two groups similar to the bleeding area, where the most basal ganglia hemorrhage, 12 cases and 17 cases each. Followed by the hypothalamus part of bleeding more, each with 7 cases and 5 cases of cerebral lobe, brain stem, cerebellum, followed by reduction of bleeding site. Ratio of the two groups similar to the bleeding area, no significant difference (P> 0.05). (5) in the 28-day follow-up, 4 deaths in the conservative treatment group who died 2 positive step-down group, the conservative treatment group mortality was 20%, higher than 7.4% positive blood pressure group, but too few sample cases , no significant difference between two groups of mortality (P> 0.05). 90-day follow-up, the situation is similar to 28 days, due to the small number of sample cases no significant difference between the mortality groups (P> 0.05). (6) in the 28-day follow-up, a positive step-down group of death and disability in patients with a total of 16 people, death / disability rates of 59.3%, death and disability in the conservative treatment group, a total of 21 patients, death / disability rates of 87.5%, compared the two groups significant difference, P <0.05. Multivariate adjusted (age, gender, past history, admission severity, complications, blood loss, bleeding site, treatment), the two death / disability rates are still significant differences compared. That the exclusion of other effects of death, disability factors, circumstances, take blood pressure in patients with acute intra-cerebral hemorrhage treated relatively conservative in terms of the treatment group may have a positive impact. Conclusion: For cerebral hemorrhage, active antihypertensive treatment can be well tolerated and can have a positive impact on the prognosis of patients and may reduce hematoma expansion. Cerebral hemorrhage 90 days 28 days better than disability. Cerebral hemorrhage prognosis by admission GCS score, complications, decreased blood pressure levels within 24 hours, blood loss, bleeding site, past medical history, the long-term post-discharge blood pressure medication, whether the line rehabilitation therapy and other factors.