脑梗死TOAST各型急性期血压进程与预后差异  

Blood Pressure Course and Outcome are Different in Acute Ischemic Stroke Subtypes according to TOAST Criteria

作　　者：尚文锦[1] 周晓明[2] 洪华[1] 

机构地区：[1]中山大学附属第一医院神经科,广东广州510080 [2]中山大学附属第六医院康复科,广东广州510655

出　　处：《中山大学学报（医学科学版）》2016年第2期260-265,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广州市科技局计划项目(2014Y2-00502)

摘　　要：【目的】研究脑梗死急性期TOAST各型的血压进程和预后差异。【方法】对36名发病24 h内入院的脑梗死患者进行了连续3 d的动态血压监测,期间未使用降压药。大动脉粥样硬化组(LAA)11人,心脏源性栓塞组(CE)3人,小动脉闭塞组(SAO)11人,其它病因组(SOD)3人,不明原因组(SUD)8人。分析的血压参数包括收缩压、舒张压、脉率、夜间血压下降率,预后包括卒中进展和3个月功能。【结果】脑梗死3 d内,TOAST各型平均收缩压、舒张压、脉率随时间变化的趋势有差异(P均<0.001)。LAA组平均收缩压、舒张压均持续升高,其余组均呈下降趋势。CE组平均收缩压、舒张压最低,平均脉率最高。TOAST各型发病3 d内夜间血压下降率降低,以非杓型为主。夜间发生高血压的百分比较白天高,尤其舒张压,LAA组最明显。LAA组3 d内血压升高者出现卒中进展和3个月功能不良的比例更高,SAO组则相反。【结论】脑梗死急性期TOAST各型的血压进程不同,血压变化对TOAST各型预后影响不同。使用动态血压监测可以协助制定更加合理的治疗方案。[Objective] To explore the difference of blood pressure course and outcome in acute ischemic stroke subtypes according to TOAST criteria. [ Methods ] Thirty-six patients diagnosed ischemie stroke in the first 24h after onset were performed 72h consecutively ambulatory blood pressure motoring. Those who used antihypertensive agents were excluded. There were 11 patients in LAA subtype, 3 patients in CE subtype, 11 patients in SAO subtype, 3 patients in SOD subtype and 8 patients in SUD subtype. BP values included SBP, DBP, P and nocturnal BP drop rate. Outcomes were neurologie deterioration and independence at 3 months. [ Results ] In the first three days after stroke onset, the courses of average systolic pressure, diastolic pressure and pulse were absolutely different in TOAST subtypes （P 〈 0.001 ）. The average SBP and DBP of LAA subtype grew unceasingly, while the BP values of other subtypes were declining. CE subtype got the lowest average SBP and DBP and the highest P. In those three days, all subtype had a decreased nocturnal blood pressure dipping and an increased ratio of nocturnal hypertension, especially the diastolic pressure and the large-artery atherosclerosis subtype.For those who had a higher average systolic pressure on Day 3 than Day 1, more patients had poor outcome in large-artery atherosclerosis subtype, while more patients had favorable outcome in small-artery occlusion subtype. [Conclusion] The blood pressure course and outcome are totally different in acute isehemic stroke subtypes according to TOAST criteria. Ambulatory blood pressure motoring may lead to more appropriate targeting of antibypertensive treatment for ischemic stroke patients.

关 键 词：脑梗死 TOAST分型 动态血压 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]