【摘要】 目的　探讨脑出血患者急性期降血压治疗的利弊和经颅多普勒超声 (TCD)监测对脑出血治疗的指导作用。方法　动态监测 6 8例 12h内入院的脑出血患者的血压 ,其中 4 0例入院 2 4h内接受血肿碎吸引流术 ,2 0例内科对症支持治疗 ,并于入院时和第 1、3、7及 14天监测TCD ;8例未手术者 (降压组 )在接受降血压治疗前、后监测TCD ,并与 2 4例单纯高血压患者 (对照组 )降血压治疗前后的TCD参数进行比较。结果　对照组降血压前后TCD参数差值无显著性 ,而降压组降压后双侧大脑中动脉 (MCA)流速降低 ,脉动指数 (PI)值升高。脑出血患者治疗过程中血压逐渐下降 ,双侧MCA流速呈先降后升 ,双侧PI值呈先升后降 ;保守治疗组MCA流速发病 1周内下降 ,第 2周开始升高 ,PI值改变与其相反 ;手术组第 7天MCA流速即开始升高 ,PI值降低 ,且在第 14天两组间差异有显著性意义 ;手术组血压下降幅度较保守组大 ,第 14天收缩压差异有显著性意义 (前者为 - 12 6± 6 8、后者为- 7 5± 4 8)。结论　微创血肿引流术可显著性改善脑出血患者的脑灌注 ,而急性期的降血压治疗不利于脑灌注 ,动态TCD监测可评估患者脑灌注状态 ,指导治疗更多还原

【Abstract】 Objective To observe the changes of TCD parameter in postsurgery and presurgery and antihypertensive therapy in acute intracerebral hemorrhage (ICH), and to evaluate whether it may benefit the cerebral perfusion or not Methods Sixty intracerebral hemorrhage patients within the first 12 hours after clinical onset were monitored with 24 hour BP and TCD in the 1st, 3rd, 7th, and 14th day after clinical onset. Among them, 40 patients were treated with medicine and stereotactic computed tomography (CT) guided drain and aspiration within the first 24 hours and 20 patients were only given medicines. Eight patients were monitored with TCD during the period of antihypertensive therapy (AHT) with nimodipine. Twenty four primary hypertensive patients (control group) only monitored with TCD before and after antihypertensive therapy Results Comparing the pulsatility index (PI) and middle cerebral artery blood flow velocity (MFV), control group had nonsignificant reduction( P >0.05), but AHT group had a significant reduction ( P <0.05). Blood pressure(BP)of ICH patients was gradually reduced during the period of therapy, while MFV was decreased in the early days, then increased, which was contrary to PI. MFV of the medication group decreased in the first week then increased in the 14th day, while the changes of PI were quite the contrary. As compared the TCD parameter of two groups, the surgery group had a change in the seventh day, while BP and the TCD parameter of the two groups had significant differences in the fourteenth day ( P <0.05) Conclusion Therapy using stereotactic computed tomography (CT) guided thrombolysis and aspiration can improve cerebral perfusion in acute intracerebral hemorrhage, however, the antihypertensive therapy in acute stage may decrease the cerebral perfusion. Ambulatory TCD monitoring can be used to evaluate the perfusion status of drain and guide the therapy in intracerebral hemorrhage.更多还原