镇静剂应用于高血压脑出血术后控制再出血的临床观察

程孟忠+李康成+吉康荣

[摘要] 目的 探讨镇静剂（丙泊酚）在高血压脑出血手术后用于再出血控制的效果。 方法 以我院120例高血压性脑出血术后患者为研究对象，进行随机分两组，分别为观察组64例和对照组56例。所有患者术后均转入重症病房进行监护，给予相同的常规治疗，观察组在常规治疗的基础上给予丙泊酚静脉泵入，在术后1、2、4、8、12、16、24、48h连续观察两组患者，进行镇静躁动评分，测量患者的收缩压和舒张压、心率及降压药的使用情况、再出血的发生率。观察和对比两组的临床疗效。 结果 术后再出血率和镇静效果评分显示观察组出血率3.1%，显著低于对照组19.6%（P<0.05），镇静起效时间更短（P<0.05），充分镇静时间更长（P<0.05）；术后1～48h观察组患者心率、收缩压、舒张压以及降压药的使用量均显著低于对照组（P<0.05）。 结论 在重症病房监控条件下，采用丙泊酚注射液应用于高血压患者脑出血术后镇静控制治疗，可以有效地控制血压，达到良好镇静效果，显著降低再出血率，在临床上具有安全、显著的治疗效果，值得推广。

[关键词] 丙泊酚；高血压；脑出血；术后镇静

[中图分类号] R651.1 [文献标识码] A [文章编号] 2095-0616（2017）06-145-03

[Abstract] Objective To investigate the effect of tranquilizers （propofol） on rebleeding after hypertensive intracerebral hemorrhage surgery. Methods 120 cases of postoperative patients with hypertensive cerebral hemorrhage in our hospital were selected as the research object. They were randomly divided into observation group and control group with 56 cases in each. All patients were transferred to the intensive care unit after surgery to give the same routine treatment. Patients in observation group were treated with propofol intravenous infusion on the basis of propofol intravenous injection. In the postoperative 1，2，4，8，12，16，24 ， 48h， sedative and restless score， measurement of patients with systolic and diastolic blood pressure， heart rate and antihypertensive drugs use， the incidence of rebleeding in the two groups were continuous observed. The clinical efficacy of the two groups were observed and compared. Results The postoperative resuscitation rate and the tranquility scale showed that the bleeding rate was 3.1% in the observation group， which was significantly lower than that in the control group （19.6%， P<0.05）， the duration of sedation was shorter （P<0.05）， the sedation time was longer （P<0.05）. The rate of heart rate， systolic blood pressure， diastolic blood pressure and antihypertensive drugs in the observation group were significantly lower than those in the control group （P<0.05）. Conclusion In the intensive ward monitoring conditions， the use of propofol injection in hypertensive patients with cerebral hemorrhage after sedation control treatment can effectively control blood pressure to achieve a good sedative effect， significantly reduce the rate of rebleeding. It has clinically safety， significant of the treatment effect， and it is worth promoting.

[Key words] Propofol； Hypertensive； Intracerebral hemorrhage； Postoperative calm

高血壓脑出血是临床上常见的导致高血压患者死亡的原因，特别是术后再出血的发生[1]。患者可能的凝血障碍、手术血肿清除太过彻底、术后血压控制不力、咳嗽吸痰、在术后伤口的撕裂、疼痛、气管插管等原因均可能导致患者的躁动而增加术后再出血的发生率，这对临床高血压患者极其危险[2-3]。丙泊酚，是一种麻醉药，起效快、半衰期短、副作用少，在低剂量时安全可靠，可以短时间内有效镇静，停药后高血压脑出血术后镇静的临床观察患者可快速恢复意识[4]。本文对我院2014年1月～2016年7月收治的120例高血压性脑出血术后患者采取随机分组，观察高血压脑出血术后患者使用丙泊酚的镇静效果。现报道如下。

1 资料与方法

1.1 一般资……