高收缩压水平脑分水岭梗死急性期升压治疗对预后影响的前瞻性研究  

Effect of Elevated Blood Pressure Treatment on Outcome of Acute Watershed Infarction with High Systolic Blood Pressure Levels

作　　者：聂志余[1] 陈玉辉[1] 李艳成[1] 封亮[1] 潘有贵[1] 管强[1] 郭艳[1] 舒豪[1] 靳令经[1] 

机构地区：[1]同济大学附属同济医院神经内科,上海200065

出　　处：《中国卒中杂志》2015年第10期835-840,共6页Chinese Journal of Stroke

基　　金：上海市卫生局科研课题(2009137)

摘　　要：目的探讨升压治疗对收缩压（systolic blood pressure，SBP）在140～160 mmHg的急性脑分水岭梗死患者预后的影响。〈br〉 方法本研究为前瞻性研究，连续选择2011年l月至2014年11月同济大学附属同济医院神经内科首次发病48 h内SBP在140～160 mmHg的急性脑分水岭梗死患者64例，分为升压治疗组29例和常规治疗组35例，升压治疗组除阿司匹林、阿托伐他汀等常规治疗外加用多巴胺升压治疗，使SBP较入院时血压上升约20 mmHg，维持3天。于入院时和2周采用美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale，NIHSS）评分、发病后6个月采用改良Rankin量表（modified Rankin Scale，mRS）评分对患者神经功能缺损评价，NIHSS减少46%以上视为升压治疗显效；mRS≤2分为预后良好。〈br〉 结果两组患者入院时年龄、性别、发病时间和NIHSS评分等基线资料差异无显著性，入院2周时升压治疗组显效率为27.6%，与常规治疗组的28.6%比较差异无显著性（P=0.930）。发病6个月升压治疗组预后良好率为65.5%，高于常规治疗组的48.6%，但差异无显著性（P=0.174）。 结论升压治疗对SBP在140～160 mmHg的急性脑分水岭梗死患者无明显疗效。Objective To investigate the effect of elevated blood pressure（BP） on outcome of patients with acute cerebral watershed infarction（CWI） with systolic blood pressure（SBP） range from 140 to 160 mmHg. Methods Sixty-four successive patients with ifrst onset acute CWI with SBP range from 140 to 160 mmHg were enrolled in this prospective analysis, which was from department of neurology, Tongji hospital, Tongji University between January 2011 and November 2014. Patients were randomly divided into elevated BP treatment group（treatment group, 29 cases） and routine treatment group（routine group, 35 cases）, Dopamine was given to elevate SBP about 20 mmHg in the treatment group besides routine ischemic stroke therapy including Aspirin and Atorvastatin etc. in the ifrst three days after admission. National Institutes of Health Stroke Scale（NIHSS） were recorded at admission and 2 weeks after admission or at discharge, modiifed Rankin Score（mRS） was collected for assessment of neurological function defect at 6 months after stroke. More than 46%decrease of NIHSS was deifned as effectivity of elevated BP treatment 2 weeks after admission or at discharge, and mRS≤2 was deifned as good outcome. Results There was no difference in baseline data including age, sex, disease time and NIHSS, etc. between two groups. The effective rate was 27.6%in treatment group and 28.6%in routine group 2 weeks after admission or at discharge. There was no statistic significance between two groups（P=0.930）. The proportion of good outcome was higher in treatment group（65.5%） than in routine group（48.6%） at six months after stroke, but there was no statistic signiifcance（P=0.174）. Conclusion Elevated BP treatment had no effect on obvious outcome in the patients with acute CWI with SBP ranged from 140 to 160 mmHg.

关 键 词：脑分水岭梗死 急性期 升压治疗 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]