血压变异与静脉溶栓治疗急性缺血性脑卒中预后的相关性

发布时间：2018-06-06 15:21

本文选题：血压变异 + 脑梗死　；参考：《第二军医大学学报》2016年10期

【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,懫用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。
[Abstract]:Objective to observe the relationship between the fluctuation of blood pressure and the prognosis of patients with acute ischemic stroke during venous thrombolysis, so as to guide the management of blood pressure during ultra-early venous thrombolysis in acute ischemic stroke. To improve the effect of super early treatment for acute ischemic stroke. Methods 198 patients (125 males and 73 females) who were diagnosed as acute ischemic stroke in our cerebrovascular center from September 2013 to December 2015 and were given recombinant tissue plasminogen activator (rt-PA) intravenous thrombolytic therapy in the time window were selected. The average age was 67.6 卤12.8 years. The neurological impairment was evaluated by NIHSS, and the prognosis was evaluated by modified Rankin scale. The changes of blood pressure were monitored at the beginning of intravenous thrombolytic therapy and during thrombolytic therapy. The evaluation indexes included mean, maximum value of max1, minimal value of minitron, extreme difference of max-mint, standard deviation of SDX, successive variability of SVV and so on. Logistic regression analysis was used to evaluate the effect of blood pressure parameters on long-term prognosis. Results the NIHSS score before thrombolysis, the time from onset to the beginning of thrombolysis, Mean systolic blood pressure before thrombolysis, pulse pressure before thrombolysis, and maximal systolic blood pressure during venous thrombolytic thrombolysis, continuous changes of systolic blood pressure (SSV), continuous variation of maximum systolic blood pressure, continuous variation of systolic blood pressure, maximum diastolic pressure, continuous variation of diastolic pressure, DSVV, maximum diastolic pressure, continuous variation of diastolic blood pressure, and continuous variation of diastolic blood pressure in the course of thrombolytic thrombolysis. Continuous changes in pressure and DSVmaxwere related factors to the clinical outcome. Multivariate logistic regression analysis showed that the short time from onset to treatment, the low score of NIHSS before thrombolysis, the low systolic blood pressure before thrombolysis, and the low variability rate of systolic blood pressure and diastolic blood pressure during thrombolysis were independent predictors of good prognosis. Conclusion the prognosis of intravenous thrombolysis is directly related to systolic blood pressure, pulse pressure and blood pressure variability during thrombolysis. The greater the variation rate of blood pressure, that is, the more obvious fluctuation of blood pressure, the more adverse to the prognosis. Maintaining stable blood pressure helps to improve prognosis.
【作者单位】：第二军医大学长海医院脑血管病中心;
【基金】：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)~~
【分类号】：R743.33

【相似文献】