脑分水岭梗死急性期升压治疗对近期和远期预后的影响  

Effect of elevated blood pressure treatment on short-term and long-term prognosis among patients with acute watershed infarction

作　　者：聂志余[1] 陈玉辉[1] 李艳成[1] 封亮[1] 靳令经[1] 

机构地区：[1]上海同济大学附属同济医院神经内科,200065

出　　处：《中国神经免疫学和神经病学杂志》2015年第5期334-337,共4页Chinese Journal of Neuroimmunology and Neurology

基　　金：上海市卫生局科研课题资助项目(2009137)

摘　　要：目的 探讨升压治疗对急性脑分水岭梗死患者近期及远期预后的影响。方法 选择首次发病24h内收缩压（SBP）在120～140mmHg的急性脑分水岭梗死患者86例,随机分为升压治疗组和常规治疗组各43例,升压治疗组在阿司匹林、阿托伐他汀药物等常规治疗的基础上给予多巴胺升压治疗,将入院时的SBP上升约20mmHg,维持3d。于入院时和入院后2周采用NIHSS评分,发病后6个月采用改良Rankin评分（mRS）和Barthel Index（BI）评估患者近期和远期疗效,NIHSS减少16%以上视为升压治疗有效;mRS≤2分定义为功能恢复良好,BI〉75定义为日常生活能力良好。结果 入院2周时升压治疗组有效率为83.7%,高于常规治疗组的62.8%（P〈0.05）。发病6个月升压治疗组mRS≤2分和BI〉75者分别占75.0%和82.5%,均高于常规治疗组的51.2%和63.2%（P〈0.01）。结论 短期升压治疗可能会改善SBP在120～140mmHg的急性脑分水岭梗死患者的近期和远期预后。Objective To investigate the effect of elevated systolic blood pressure （SBP） treatment on short-term as well as long-term prognosis among patients with acute watershed infarction. Methods Eighty-six patients with first-ever onset acute cerebral watershed infarction within 24 hours after onset and SBP between 120 mmHg and 140 mmHg at admission from January 2009 to June 2014 were enrolled in this prospective analysis. They were randomly divided into the elevated blood pressure （BP） treatment group （the treatment group, 43 cases） and the routine treatment group （the routine group, 43 cases）. Dopamine was given to elevate SBP by about 20 mmHg in the treatment group besides routine ischemic stroke therapy in the first 3 days after admission. National Institutes of Health Stroke Scale （NIHSS） was recorded at admission and 2 weeks after admission. The modified Rankin Score （mRS） and Barthel Index （BI） were assessed for long-term outcome 6 months after onset. The short-term outcome was graded as basic recovery （91%-100%）, most improved （46%-90%）, improved （16%-45%）, invalid （0-15%） and clinical exacerbation （〈0） based on NIHSS score at discharge. The elevated SBP treatment was considered effective if NIHSS score reduced more than 16%. The basic recovery, most improved and improved were defined as effectivity, and the scores of mRS,2 and BI〉 75 respectively were defined as good long-term outcome. Results The effective rate was higher （83.7%） in the patients treatment group than the routine group （62.8%） 2 weeks after admission （P〈0.05） . The proportions of with mRS,2 and BID75 in the treatment group were 75.0% and 82.5% 6 months after onset respectively, they were significantly higher than those of the routine group （51.2%, 63.2%, P〈0.01, respectively）. Conclusions The elevated SBP treatment could improve both the short term and long-term outcomes in patients with acute cerebral watershed infarction with SBP ranged from 120 to 140 mmHg.

关 键 词：脑梗死 升压治疗 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]