脑梗死急性期降压治疗对3个月预后的影响  

Influnence of blood-pressure reduction on long-term prognosis in patients with acute ischemic stroke

作　　者：王大力[1] 花楠[2] 彭延波[1] 张江[1] 

机构地区：[1]河北联合大学附属医院神经内科二病区,唐山063000 [2]河北联合大学,唐山063000

出　　处：《中国实用神经疾病杂志》2015年第3期5-7,共3页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨脑梗死急性期降压治疗与3个月预后的关系,为急性脑梗死患者血压管理提供依据。方法将入选的452例急性脑梗死患者依据发病前2周内是否服用降压药物分为2个亚组,将两亚组随机分为干预组和对照组。干预组给予降压治疗[入院24h内收缩压（SBP）下降10%-20%,7-14d血压140/90mmHg（1mmHg=0.133kPa）以下],对照组不降压。动态监测所有患者14d内的血压变化,并记录入院时基本资料及3个月死亡/主要残疾及复发等情况。结果 2个亚组中,干预组和对照组死亡/残疾比率差异均无统计学意义（P〉0.05）,只有在近期服用降压药物患者中,干预组复发率明显低于对照组（P〈0.05）,而在近期未服用降压药物患者中,2组复发率无明显差别（P〉0.05）。分别对两亚组患者进行多因素Logistic回归分析显示,在调整年龄、高血压史、入院SBP、入院NIHSS评分、3个月SBP及3个月内服用降压药情况等因素后,急性期降压治疗均不影响急性脑梗死3个月预后。结论脑梗死患者急性期给予适度降压治疗不能增加或降低3个月死亡/致残和复发的风险,所以血压管理需依据病情实行个体化原则。Objective To explore the influnence of antihypertension on long-term prognosis in patients with acute cerebral infarction and provide guidance for clinical treatment.Methods Totally 452 cases of patients with acute ischemic stroke were divided into two subgroup whether to take in antihypertensive agent within 2weeks of symptom onset.The two subsets participants were randomly divided into blood pressure intervention group and control group.Antihypertensive therapy was given to the intervention group,with the target of lowering systolic blood pressure by 10%to 20% within the first 24 hours after randomization,blood pressure140/90 mmHg in the 7to 14 days.However,the control group discontinued all antihypertensive medications.Blood pressures were monitored from day to 14 of admission.Baseline characteristics,the condition of death/major disability and recurrent stroke of the two groups within 3 months were observed.Results Among participants in the two subgroup,antihypertensive agent have no diffence between treatment group and control group.Only in the subgroup who took in antihypertensive agent recently,does the treatment group have a lower recurrent stroke.However there are no deffence in the other subgroup.By using multiple logistic regression analysis adjusted for age,history of hypertension,NIHSS scores after admission and so on,antihypertensive therapy in acute phase does not influence 3month prognosis of patients with cerebral infarction.Conclusion This trial indicates that antihypertensive treatment in patients with acute ischemic stroke does not decrease or increase the risk of adverse death/major disability and recurrent stroke.So clinical management of hypertension among acute ischemic stroke patients should be an individual decision based on comorbidities and cotreatments.

关 键 词：脑梗死 高血压 降压治疗 预后 死亡 残疾 复发 

分 类 号：R743.33[医药卫生—神经病学与精神病学]