| 摘要: |
| 目的 观察急性缺血性脑卒中静脉溶栓过程中血压波动幅度与患者预后的关系，以指导急性缺血性脑卒中超早期静脉溶栓期间的血压管理，提高急性缺血性脑卒中超早期治疗的疗效。方法 选择2013年9月至2015年12月在我院脑血管病中心诊断为急性缺血性脑卒中并在时间窗内给予重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓的患者198例，其中男性125例、女性73例，年龄22~91岁，平均年龄（67.6±12.8）岁。根据NIHSS评分评价患者神经系统功能缺损，采用改良Rankin量表（modified Rankin scale，mRS）评分评价患者预后。监测静脉溶栓开始及溶栓过程中血压变化水平，评估指标包括均值（mean）、极大值（max）、极小值（min）、极差（max-min）、标准差（SD）、连续变异度（successive variation，SV）等。在各基线资料的校正下，釆用logistic回归分析评估血压参数对远期预后的影响。结果 患者溶栓前NIHSS分值、发病至溶栓开始的时间、平均溶栓前收缩压（S0）、平均溶栓前脉压（P0）以及在静脉溶栓过程中最大收缩压（Smax）、收缩压连续变化（SSV）、最大收缩压连续变化（SSVmax）、舒张压最大值（Dmax）、舒张压连续变化（DSV）、最大舒张压连续变化（DSVmax）等为影响临床结局的相关因素。多因素logistic回归分析表明发病至治疗时间短、溶栓前NIHSS评分低、溶栓前收缩压值低，溶栓过程中连续的收缩压及舒张压血压变异率低为预后良好的独立预测因素。结论 静脉溶栓预后与溶栓开始时的收缩压、脉压及溶栓过程中血压变异率直接相关。血压的变异率越大，即血压的波动越明显，对预后越不利。维持稳定的血压有助于改善预后。 |
| 关键词: 血压变异 脑梗死 血栓溶解疗法 组织型纤溶酶原激活物 |
| DOI：10.16781/j.0258-879x.2016.10.1201 |
| 投稿时间：2016-04-26修订日期：2016-09-06 |
| 基金项目:上海市科委医学引导项目（124119a8900），上海申康医院发展中心临床管理优化项目（SHDC2015607）. |
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| Relationship between blood pressure variability and prognosis in acute ischemic stroke patients receiving intravenous thrombolysis |
| JIANG Yi,ZHANG Yong-wei,WU Tao,DENG Ben-qiang* |
(Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To observe the relation between blood pressure fluctuation and prognosis of patients with acute ischemic stroke during intravenous thrombolysis, so as to guide the blood pressure management during super early stage of acute ischemic stroke and to improve the prognosis after intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA). Methods A total of 198 acute ischemic stroke patients,who received rt-PA intravenous thrombolysis during the time window between Sep. 2013 to Dec. 2015 in our stroke center, were included in this study, and the patients included 125 males and 73 females, aged (67.6±12.8) years old, ranging 22-91 years.NIHSS score was used to evaluate the function of the nervous system and modified Rankin Scale (mRS) score was used for evaluating the prognosis of patients. The blood pressure variation during the entire process of intravenous thrombolysis, which included the mean, maximum (max), minimum (min), range (max-min), standard deviation (SD), and successive variation(SV), were monitored. After baseline data correction,multiple logistic regression analysis was used to evaluate the influence of blood pressure on the long-term prognosis of patients. Results We found that the initial NIHSS score, time from onset to thrombolysis, average initial systolic blood pressure, and average initial pulse pressure, the maximum systolic/diastolic blood pressure during thrombolysis, SV of systolic/diastolic blood pressure during thrombolysis, and SV of the maximum systolic/diastolic blood pressure during thrombolysis, were the factors affecting the clinical outcomes of patients (P<0.05, P<0.01). The multiple logistic regression analysis showed that low initial NIHSS score, shorter time from onset to thrombolysis, low average initial systolic blood pressure, and low SV of systolic blood pressure and diastolic pressure were the independent predicting factors for good prognosis of acute ischemic stroke patients receiving rt-PA intravenous thrombolysis. Conclusion The prognosis of acute ischemic stroke is associated with the systolic blood pressure at beginning of thrombolysis, pulse pressure and pressure variability during thrombolysis. Great blood pressure fluctuation is associated with poor outcome of acute ischemic stroke, so efforts should be made to maintain stable blood pressure in the patients. |
| Key words: blood pressure variability brain infarction thrombolytic therapy tissue plasminogen activator |
