彭敏 段继新 于汉昌 王承

【摘要】 目的 探讨小剂量地塞米松治疗急性高血压脑出血患者术后顽固性脑水肿的临床效果。

方法 选择2018年10月～2019年10月收治的急性高血压脑出血术后顽固性脑水肿患者60例，依据随机数字表分为观察组（n=30）及对照组（n=30）。对照组行大剂量地塞米松治疗;观察组术后第3天开始加用小剂量地塞米松治疗。比较两组手术前后脑水肿面积、美国国立卫生研究院卒中量表（NIHSS）评分、格拉斯哥昏迷量表（GCS）评分。

结果 术后4 d、6 d、9 d、12 d，两组脑水肿面积均大于术前，差异有统计学意义（P<0.05）;但手术后两组水肿面积随时间延长而减小，且观察组均小于对照组，差异有统计学意义（P<0.01）。术前两组NIHSS评分、GCS评分组间比较，差异均无统计学意义（P>0.05）;手术后2周，两组NIHSS评分低于术前，且觀察组低于对照组，两组GCS评分明显高于术前，且观察组高于对照组，差异有统计学意义（P<0.01）。

结论 小剂量地塞米松治疗急性脑出血术后顽固性脑水肿可有效减小脑水肿面积，促进患者神经功能恢复，改善患者意识状态。

【关键词】 急性高血压脑出血;顽固性脑水肿;地塞米松

中图分类号：R651.1+9    文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.03.010

Clinical analysis of low dose dexamethasone in the treatment of postoperative intractable cerebral edema in patients with acute hypertensive intracerebral hemorrhage

PENG Min， DUAN Jixin， YU Hanchang， WANG Cheng

（Department of Neurosurgery， Changsha Hospital of Traditional Chinese Medicine—Changsha Eighth Hospital， Changsha 410100， Hunan， China）

【Abstract】 Objective To investigate the clinical effect of low-dose dexamethasone in the treatment of postoperative intractable cerebral edema in patients with acute hypertensive intracerebral hemorrhage.

Methods 60 patients with postoperative intractable cerebral edema after operation of acute hypertensive cerebral hemorrhage who admitted to hospital from October 2018 to October 2019 were selected and randomly divided into observation group （n = 30） and control group （n = 30）. The control group were treated with high dose dexamethasone， and the observation group were treated with low dose dexamethasone from the third day after operation. And then， brain edema area， the National Institutes of Health Stroke Scale（NIHSS） score and Glasgow Coma Scale （GCS） score before and after operation were compared between the two groups.

Results 4 d， 6 d， 9 d and 12 d after operation， the areas of brain edema in the two groups were larger than those before operation， and difference was statistically significant （P < 0.05）. After operation， however， the edema areas of the two groups decreased with time， and that of the observation group was smaller than that of the control group， and difference was statistically significant （P < 0.01）. There were no statistically significant differences in NIHSS scores and GCS scores between the two groups before operation （P > 0.05）. 2 weeks after operation， NIHSS scores of the two groups were lower than those before operation， and that of the observation group was lower than that of the control group， GCS scores of the two groups were significantly higher than those before operation， and that of the observation group was higher than that of the control group， and difference was statistically significant （P < 0.01）.

Conclusion Low dose dexamethasone in the treatment of postoperative intractable cerebral edema after acute cerebral hemorrhage can effectively reduce the area of cerebellar edema， promote the recovery of neurological function and improve the state of consciousness of patients.

【Key words】 acute hypertensive cerebral hemorrhage; intractable cerebral edema; dexamethasone

顽固性脑水肿是高血压脑出血术后常见的并发症其病程较长，容易引起脑组织严重缺血缺氧，造成脑神经永久性损伤，继而对患者预后造成严重影响[1]。地塞米松是一种糖皮质激素，具有抗炎、免疫抑制作用，可有效减轻脑水肿，促进患者神经功能恢复。本研究探讨小剂量地塞米松治疗急性脑出血患者术后顽固性脑水肿的临床效果，旨在为此方案的临床应用提供依据。

1 资料与方法

1.1 一般资料

经医学伦理委员会批准，选择2018年10月～2019年10月于我院治疗的急性高血压脑出血术后顽固性脑水肿患者60例，依据随机数字表分为观察组（n=30）及对照组（n=30）。……