缺血性卒中静脉溶栓后早期血压波动与溶栓预后的关系

发布时间：2018-05-31 05:44

  本文选题：缺血性卒中 + 静脉溶栓治疗　； 参考：《浙江大学》2015年博士论文

【摘要】：研究目的： 高血压是卒中的独立风险因素之一。越来越多的研究显示,血压变异在卒中的发生及预后中起重要作用。本研究探讨缺血性卒中静脉溶栓后早期血压变异与出血转化、组织再灌及远期预后之间的关系。 研究方法： 回顾性分析2009年6月至2014年10月本院接受静脉溶栓治疗的急性缺血性卒中患者的临床及影像学资料。监测静脉溶栓后24小时内每小时血压值,血压变化水平评估指标包括：均值(mean),极大值(max),极小值(min),极差值(max-min),标准差(SD),连续变异度(successive variation, SV),血压升值连续变异度(SVrise)与最大升值变异(SVmaXrise),血压降值连续变异度(SVdrop)与最大降值变异(SVmaxdrop)。根据欧洲急性卒中二期试验(The Second European Cooperative Acute Stroke Study, ECASS-Ⅱ),将出血转化分为渗血型(hemorrhagic infarction, HI)和血肿型(parenchymal hematoma, PH),将症状性出血定义为美国国立卫生研究所脑卒中评分标准(the National Institute of Health Stroke Scale, NIHSS)评分≥4分或致死的出血转化。根据磁共振灌注影像,将达峰时间(Tmax)6秒定义为低灌区,以24小时复查复灌率50%定义为再灌。将3月改良Rankin评分(mRS)≥2分定义为远期预后不良。在各基线资料的校正下,采用logistic回归分析血压参数对出血转化、症状性出血、再灌和远期预后的影响。 研究结果： 461例患者纳入出血、预后分析,其中142(30.8%)例患者发生出血转化,出血分型如下：36(7.8%)例HI-1型,63(13.7%)例HI-2型,19(4.1%)例PH-1型,24(5.2%)例PH-2型。12(2.6%)例患者发生症状性出血。96例患者纳入再灌分析,其中57(59.4%)达到再灌。多因素分析校正后,静脉溶栓后24小时内收缩压(SBP) SD (每10%,OR=1.994,95%CI:1.05-3.78, p=0.033),SV(每10%, OR=2.322,95%CI:1.09-4.93, p=0.028), SVmaxrise(每10mmHg, OR=1.321,95%CI:1.01-1.72, p=0.040)为PH型出血的独立风险因素。SBP极差值(每1OmmHg, OR=1.340,95%CI:1.06-1.69, p=0.014), SD(每10%, OR=4.538,95%CI:1.83-11.23, p=0.001), SV(每10%, OR=6.117,95%CI:2.00-18.71, p=0.002), SVmaxrise(每10mmHg, OR=1.574,95%CI:1.05-2.36, p=0.029)为症状性出血的独立风险因素。收缩压均值(每10mmHg, OR=1.344,95%CI:1.15-1.57, p0.001),极大值(每10mmHg,OR=1.266,95%CI:1.12-1.42, p0.001),极小值(每1OmmHg, OR=1.196,95%CI:1.02-1.40, p0.001),极差值(每10mmHg, OR=1.209,95%CI:1.05-1.39, p=0.008),SD(每10%,OR=1.882,95%CI:1.06-3.33, p=0.030), SV(每10%,OR=3.998,95%CI:2.20-7.26, p0.001), SVmaxrise(每10mmHg, OR=1.618,95%CI:1.29-2.01, p0.001), SVmaxdrop(每10mmHg, OR=1.389,95%CI:1.13-1.69, p=0.001)是远期预后不良的独立风险因素。静脉溶栓后6小时内收缩压SVrise越高,患者再灌可能性越低(每10%, OR=0.922,95%CI:0.86-0.99, p=0.025)。 研究结论： 收缩压变异度是预测急性缺血性卒中患者静脉溶栓后发生PH型出血、症状性出血的独立危险因素,而收缩压均值水平和变异度均为远期预后不良的独立危险因素。静脉溶栓后超早期收缩压正向波动大,患者不易再灌。
[Abstract]:Objectives of the study: Hypertension is one of the independent risk factors for stroke. More and more studies show that blood pressure variation plays an important role in the occurrence and prognosis of stroke. The purpose of this study was to investigate the relationship between early blood pressure variation, hemorrhage transformation, tissue reperfusion and long term prognosis after intravenous thrombolysis in ischemic stroke. Research methods: The clinical and imaging data of patients with acute ischemic stroke treated with intravenous thrombolysis from June 2009 to October 2014 were retrospectively analyzed. Blood pressure was monitored within 24 hours after intravenous thrombolysis. The evaluation indexes of blood pressure change level include mean value, maximum value, minimum value, extremely difference value, standard deviation, successive variation, continuous variability, continuous variation of blood pressure appreciation, and maximum value of appreciation, continuous variation and continuous variation of blood pressure drop value (SVdrop1) and maximum drop value variation of SVmax dropper. According to the Second European Cooperative Acute Stroke Study, ECASS- 鈪，

本文编号：1958518