The George Institute for International Health, Royal Prince Alfred Hospital and the University of Sydney, Sydney, Australia.
Stroke. 2010 Feb;41(2):307-12. doi: 10.1161/STROKEAHA.109.561795. Epub 2009 Dec 31.
The Intensive Blood Pressure Reduction In Acute Cerebral Haemorrhage Trial (INTERACT) study suggests that early intensive blood pressure (BP) lowering can attenuate hematoma growth at 24 hours after intracerebral hemorrhage. The present analyses aimed to determine the effects of treatment on hematoma and perihematomal edema over 72 hours.
INTERACT included 404 patients with CT-confirmed intracerebral hemorrhage, elevated systolic BP (150 to 220 mm Hg), and capacity to start BP-lowering treatment within 6 hours of intracerebral hemorrhage. Patients were randomly assigned to an intensive (target systolic BP 140 mmHg) or standard guideline-based management of BP (target systolic BP 180 mm Hg) using routine intravenous agents. Baseline and repeat CTs (24 and 72 hours) were performed using standardized techniques with digital images analyzed centrally. Outcomes were increases in hematoma and perihematomal edema volumes over 72 hours.
Overall, 296 patients had all 3 CT scans available for the hematoma and 270 for the edema analyses. Mean systolic BP was 11.7 mm Hg lower in the intensive group than in the guideline group during 1 to 24 hours. Adjusted mean absolute increases in hematoma volumes (mL) at 24 and 72 hours were 2.40 and 0.15 in the guideline group compared with -0.74 and -2.31 in the intensive group, respectively, an overall difference of 2.80 (95% CI, 1.04 to 4.56; P=0.002). Adjusted mean absolute increases in edema volumes (mL) at 24 and 72 hours were 6.27 and 10.02 in the guideline group compared with 4.19 and 7.34 in the intensive group, respectively, for an overall difference of 2.38 (95% CI, -0.45 to 5.22; P=0.10).
Early intensive BP-lowering treatment attenuated hematoma growth over 72 hours in intracerebral hemorrhage. There were no appreciable effects on perihematomal edema.
强化降压治疗急性脑出血试验（INTERACT）研究表明，脑出血后 24 小时内早期强化降压可以减轻血肿扩大。本分析旨在确定治疗对血肿和血肿周围水肿在 72 小时内的影响。
INTERACT 纳入了 404 例 CT 证实的脑出血、收缩压升高（150 至 220mmHg）和有能力在脑出血后 6 小时内开始降压治疗的患者。患者被随机分配到强化（目标收缩压 140mmHg）或标准指南为基础的血压管理（目标收缩压 180mmHg）组，使用常规静脉药物。使用标准化技术进行基线和重复 CT（24 小时和 72 小时）检查，并进行数字图像的中心分析。结果为 72 小时内血肿和血肿周围水肿体积的增加。
总体而言，296 例患者有所有 3 次 CT 扫描的血肿数据，270 例患者有水肿分析的数据。强化组在 1 至 24 小时内的平均收缩压比指南组低 11.7mmHg。调整后的血肿体积（mL）在 24 小时和 72 小时的平均绝对增加值在指南组分别为 2.40 和 0.15，而强化组分别为-0.74 和-2.31，总体差异为 2.80（95%CI，1.04 至 4.56；P=0.002）。调整后的水肿体积（mL）在 24 小时和 72 小时的平均绝对增加值在指南组分别为 6.27 和 10.02，而强化组分别为 4.19 和 7.34，总体差异为 2.38（95%CI，-0.45 至 5.22；P=0.10）。
脑出血早期强化降压治疗可减轻 72 小时内血肿的扩大。对血肿周围水肿没有明显影响。
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