Krel Mark, Brazdzionis James, Wiginton James G, Miulli Dan E, Wacker Margaret Rose, Cortez Vladimir
Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA.
Neurosurgery, Arrowhead Regional Medical Center, Colton, USA.
Cureus. 2019 Jul 23;11(7):e5215. doi: 10.7759/cureus.5215.
Background Tight blood pressure control is critical in neurosurgical patients. Systolic blood pressure (SBP) must be low enough to avoid injury and minimize intraparenchymal hemorrhage (IPH) but high enough to maintain cerebral perfusion. American Heart Association (AHA) guidelines recommend SBP <140 in intracerebral hemorrhage. This paper sought to elucidate the effect of early control of SBP on IPH expansion. Methods 134 patients with spontaneous IPH between 2011 and 2015 were analyzed utilizing chart review. Initial versus follow-up bleed size, presentation and discharge condition, discharge disposition, and blood pressure control adequacy were analyzed using the generalized linear model. Results Altered mental status was the most common presenting complaint (78%). Presenting GCS failed to demonstrate a significant main effect. Age, initial IPH volume, presenting SBP, and one-hour SBP significantly affected IPH percent expansion (p=0.002, =0.002, <0.0005, and =0.026). Several two-way interactions affected IPH percent change implying synergistic effects of the predictor variables. Conclusion Patients aged 60-70 years had the largest percent IPH expansion followed by patients aged 20-30 years. Initial IPH volume of 65.23-78.26 ml showed the largest expansion. Initial IPH volume of 52.18-65.22 ml demonstrated the least percentage of IPH expansion. One-hour control of SBP to binned groups of 111-121 mmHg or 121-132 mmHg portends relative minima in bleed expansion corresponding with AHA recommendations for IPH patients. This study suggests that this degree of early and aggressive control of SBP is achievable, safe, and may minimize IPH expansion. Future studies are needed to elucidate the role of co-morbidities and to confirm these findings in broader populations.
严格控制血压对神经外科患者至关重要。收缩压（SBP）必须足够低以避免损伤并使脑实质内出血（IPH）最小化，但又要足够高以维持脑灌注。美国心脏协会（AHA）指南建议脑出血患者的SBP<140。本文旨在阐明早期控制SBP对IPH扩大的影响。方法：通过病历回顾分析了2011年至2015年间134例自发性IPH患者。使用广义线性模型分析初始与随访时的出血大小、临床表现和出院情况、出院处置以及血压控制的充分性。结果：意识状态改变是最常见的主诉（78%）。入院时的格拉斯哥昏迷量表（GCS）评分未显示出显著的主要影响。年龄、初始IPH体积、入院时SBP和1小时SBP显著影响IPH扩大百分比（p=0.002、=0.002、<0.0005和=0.026）。几个双向交互作用影响IPH百分比变化，这意味着预测变量之间存在协同效应。结论：60 - 70岁患者的IPH扩大百分比最大，其次是20 - 30岁患者。初始IPH体积为65.23 - 78.26 ml时显示出最大的扩大。初始IPH体积为52.18 - 65.22 ml时，IPH扩大百分比最小。将SBP在1小时内控制在111 - 121 mmHg或121 - 132 mmHg分组范围内预示出血扩大相对最小，这与AHA对IPH患者的建议相符。本研究表明，这种早期积极控制SBP的程度是可以实现的、安全的，并且可能使IPH扩大最小化。未来需要开展研究以阐明合并症的作用，并在更广泛的人群中证实这些发现。
