急性缺血性卒中静脉溶栓患者急性期积极降压对再灌注的影响分析

摘要

Objective To investigate the effect of positive reduction of blood pressure on reperfusion of patients with acute ischemic stroke by intravenous thrombolysis.Methods A total of 96 acute ischemic stroke patients with intravenous thrombolysis of rt-PA and systolic blood pressure 150 to 185 mmHg selected and randomly divided into observation group and control group,48 cases in each group.The patients in the observation group received positive reduction of blood pressure in the acute phase,which indicated the systolic blood pressure was controlled at 140 to 150 mmHg and maintained at least 72 h in the beginning of 60 minutes.Patients in the control group received standard blood pressure according to the guidelines,which indicated systolic blood pressure control below 180 mmHg.The patients in both groups were given multi mode MRI examination before and 24 h,48 h and 72 h after intravenous thrombolysis.The levels of blood pressure,National Institute of Health stroke scale (NIHSS),blood flow reperfusion and recanalization of the two groups were recorded.The two groups were followed up for a period of three months.The survival status and the modified Rankin scale scores of the two groups were observed.Results Compared with the control group,the systolic blood pressure of 24,48 and 72 h in the observation group were lower than that of the control group,but there was no significant difference in diastolic blood pressure and NIHSS scores in the two groups (P ＞ 0.05).There were no significant differences between the two groups in the rate of spontaneous intracerebral hemorrhage,survival rate,modified Rankin score (0 ～ 2),blood flow reperfusion rate and vascular recanalization rate (P ＞ 0.05).Conclusion Acute venous thrombosis in the acute phase of reperfusion for acute ischemic stroke patients has no adverse effects on reperfusion and no increase of morbidity and death risk of patients,and intravenous thrombolysis to avoid systolic pressure rise can improve the prognosis of patients.%目的 探讨急性缺血性卒中静脉溶栓患者急性期积极降压对再灌注的影响.方法 选取行重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗且收缩压在150～ 185 mmHg的96例急性缺血性卒中患者,随机将其分为观察组和对照组,每组48例.观察组患者在急性期采取积极降压,即在溶栓开始60 min内将收缩压控制在140～150 mmHg并至少维持72 h;对照组患者按照指南标准降压,即将收缩压控制在180 mmHg以下.2组患者在静脉溶栓前及溶栓后24、48及72 h给予多模式核磁共振检验,记录2组治疗后的血压水平、美国国立卫生研究院卒中量表(NIHSS)评分、血流再灌注及血管再通情况,对2组随访3个月,观察2组生存状态及改良Rankin量表评分.结果 与对照组比较,观察组患者在静脉溶栓后24、48及72 h的收缩压水平均显著较低(P＜0.05),而2组同时期舒张压、NIHSS评分及溶栓后24 h血管分级比较差异均无统计学意义(P＞0.05);2组3个月自发性脑内出血率、生存率、改良Rankin评分为0～2分、血流再灌注率及血管再通率比较,差异均无统计学意义(P＞0.05).结论 急性缺血性卒中静脉溶栓患者急性期积极降压对再灌注未见不良影响,亦不会增加患者致残或死亡风险,提示静脉溶栓后早期避免收缩压骤升可能利于改善患者预后.