超早期强化降压对脑出血血肿扩大、血浆基质金属蛋白酶-9及神经功能的影响

目的  探讨超早期强化降压治疗对基底节区脑出血血肿扩大、血浆基质金属蛋白酶（MMP）-9、脑水肿和神经功能的影响。方法  前瞻性纳入发病4 h内的脑出血患者134例，随机分为两组，强化降压组（67例）完成3次颅脑CT检查的患者为60例，普通降压组（67例）完成3次颅脑CT检查的患者为62例。分别在开始治疗后的1 h内采用静脉点滴降压药物使收缩压控制在130～140 mmHg、160～180 mmHg，并维持24 h。于治疗前、后进行美国国立卫生院神经功能缺损（NIHSS）评分、改良Rankin量表（mRS）评分、血浆MMP-9水平测定、颅脑CT检查，计算血肿量、血肿扩大例数和水肿量，进行组间比较。结果  治疗后14 d强化降压组NIHSS评分明显低于普通降压组（P <0.05），治疗后90 d强化降压组评分为中重度残疾或死亡患者的比例明显低于普通降压组（P <0.05）。强化降压组治疗后24 h血肿量、血肿扩大患者比例明显小于普通降压组（均P <0.05）。强化降压组治疗后5 d水肿量、血浆MMP-9水平明显低于普通降压组（均P <0.05）。结论  基底节区脑出血患者超早期强化降压治疗能够减少血肿扩大、降低血浆MMP-9水平、减轻脑水肿，进而改善患者的神经功能。

Effects of super-early intensive antihypertensive therapy on intracerebral hematoma expansion, plasma MMP-9 and neurological function

Objective To investigate the effects of super-early intensive antihypertensive treatment on the enlargement of hematoma, plasma matrix metalloproteinase 9 (MMP-9), brain edema and neurological function in patients with acute basal ganglia hemorrhage. Methods Totally 134 patients who had spontaneous super-early basal ganglia hemorrhage within the previous 4 hours were prospectively studied and randomly divided into strengthening antihypertensive group (67 cases) and normal antihypertensive group (67 cases). In the strengthening antihypertensive group 60 patients had completed three brain CT scans, while in the normal antihypertensive group 62 patients had completed three brain CT scans. The antihypertensive agents were used intravenously to reduce systolic blood pressure (SBP) to the level of 130-140 mmHg or 160-180 mmHg within 1 h after treatment, then SBP was maintained for 24 h. Before and after treatment, the National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin Scale (mRS) score were assessed, plasma MMP-9 was detected and cranial CT was performed. The hematoma volume, number of cases of hematoma enlargement and edema volume were measured and compared between both groups. Results The NIHSS score in the strengthening antihypertensive group was significantly lower than that in the normal antihypertensive group on the 14th day after treatment (P < 0.05). On the 90th day after treatment, the proportion of moderately and severely disabled patients or death cases in the strengthening antihypertensive group was significantly lower than that in the normal antihypertensive group (P < 0.05). The hematoma volume and number of cases of hematoma enlargement in the strengthening antihypertensive group were significantly smaller than those in the normal group at 24 h after treatment (P < 0.05). The edema volume was significantly smaller in both groups and plasma MMP-9 level was significantly lower in the strengthening antihypertensive group than in the normal group on the 5th d after treatment (all P < 0.05). Conclusions Super-early strengthening antihypertensive treatment could prevent expansion of intracerebral hematoma, relieve perihematomal edema, reduce plasma MMP-9 level, and improve neurologic function of patients with basal ganglia hemorrhage.