急性缺血性脑卒中围溶栓期理想血压研究  

Optimal blood pressure during peri-thrombolysis period of acute ischemic stroke

作　　者：唐逸 李娇娇 周芯羽 王娜 孟品 张洪高 郭振委 颜虹杰 庞灵恩 张健煜 胡婷婷 于杰 何明利 Tang Yi;Li Jiaojiao;Zhou Xinyu;Wang Na;Meng Pin;Zhang Honggao;Guo Zhenwei;Yan Hongjie;Pang Ling'en;Zhang Jianyu;Hu Tingting;Yu Jie;He Mingli(Department of Neurology,Lianyungang Hospital Affiliated to Xuzhou Medical University,Lianyungang 222002,China;Department of Emergency,Lianyungang Hospital Affiliated to Xuzhou Medical University,Lianyungang 222002,China)

机构地区：[1]徐州医科大学附属连云港医院神经内科,连云港市国家高级卒中中心,连云港222002 [2]徐州医科大学附属连云港医院急诊科,连云港222002

出　　处：《中华神经医学杂志》2020年第4期355-364,共10页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金(81970348)。

摘　　要：目的探讨急性缺血性脑卒中患者围溶栓期(入院时至静脉溶栓后24 h)血压对颅内出血、神经功能改善、一级终点事件和二级终点事件的影响。方法对自2015年1月至2019年3月于连云港市国家高级卒中中心接受阿替普酶静脉溶栓并随访90 d的422例急性缺血性脑卒中患者,依据其围溶栓期平均收缩压/舒张压分别五分位数分组为<130.00 mmHg组(Q1组)、130.00~140.49 mmHg组(Q2组)、140.50~147.99 mmHg组(Q3组)、148.00~158.00 mmHg组(Q4组)、>158.00 mmHg组(Q5组)及<71.30 mmHg组(G1组)、71.30~76.19 mmHg组(G2组)、76.20~81.89 mmHg组(G3组)、81.90~90.79 mmHg组(G4组)、>90.79 mmHg组(G5组)。采用单因素及多因素Logistic回归分析评估患者血压与术后颅内出血、神经功能改善的关系,采用Kaplan-Meier曲线、Log-rank检验及多因素Cox比例风险模型评估患者血压与一级终点事件(症状性脑卒中复发)、二级终点事件(复合心脑血管事件及全因死亡)的关系。结果(1)校正混杂因素后,多因素Logistic回归分析显示Q2组患者术后颅内出血风险较Q5组明显降低,差异有统计学意义(OR=0.160,95%CI:0.031~0.827,P=0.029)。(2)校正混杂因素后,多因素Logistic回归分析显示Q2组、Q3组患者术后90 d神经功能改善概率较Q5组明显升高,差异有统计学意义(OR=2.144,95%CI:1.043~4.407,P=0.038;OR=2.224,95%CI:1.105~4.479,P=0.025),G3、G4组患者术后90 d神经功能改善概率较G5组明显升高,差异有统计学意义(OR=2.153,95%CI:1.081~4.287,P=0.029;OR=2.182,95%CI:1.131~4.210,P=0.020)。(3)校正混杂因素后,多因素Cox比例风险模型显示Q1组、Q2组一级终点事件发生风险较Q5组明显降低,差异有统计学意义(HR=0.079,95%CI:0.010~0.613,P=0.015;HR=0.211,95%CI:0.062~0.724,P=0.013)。(4)校正混杂因素后,多因素Cox比例风险模型显示Q1组、Q2组、Q3组、Q4组二级终点事件发生风险较Q5组明显降低,差异有统计学意义(HR=0.246,95%CI:0.100~0.607,P=0.002;HR=0.360,95%CI:0.Objective To explore the influence of blood pressure during peri-thrombolysis period(from admission to 24 h after thrombolysis)in intracranial hemorrhage,improvement of neurological function,primary endpoint event(recurrence of symptomatic stroke)and secondary endpoint events(complex cardiovascular and cerebrovascular events,and all-cause death)in patients with acute ischemic stroke.Methods A total of 422 patients with acute ischemic stroke who underwent intravenous thrombolysis with alteplase during hospitalization at National Center for Stroke in Lianyungang from January 2015 to March 2019 were followed up for 90 d.According to the quintile of mean systolic and diastolic blood pressures during peri-thrombolysis period,they were divided into group of blood pressure<130.00 mmHg(Q1),group of blood pressure of 130.00-140.49 mmHg(Q2),group of blood pressure of 140.50-147.99 mmHg(Q3),group of blood pressure of 148.00-158.00 mmHg(Q4),and group of blood pressure>158.00 mmHg(Q5),and group of blood pressure<71.30 mmHg(G1),group of blood pressure of 71.30-76.19 mmHg(G2),group of blood pressure of 76.20-81.89 mmHg(G3),group of blood pressure of 81.90-90.79 mmHg(G4),group of blood pressure>90.79 mmHg(G5).Univariate and multivariate Logistic regression analyse were used to evaluate the relations of blood pressure with postoperative intracranial hemorrhage and neurological function improvement.Kaplan-Meier curve,Log-rank test and multivariate Cox proportional risk model were used to evaluate the relations of blood pressure with primary endpoint event and secondary endpoint events.Results(1)After adjusting for confounding factors,multivariate Logistic regression analysis showed that the risk of postoperative intracranial hemorrhage in patients from Q2 was significantly lower than that in patients from Q5(OR=0.160,95%CI:0.031-0.827,P=0.029).(2)After adjusting for confounding factors,multivariate Logistic regression analysis showed that the probability of postoperative improvement of nerve function in patients from Q2 and Q3 was

关 键 词：急性缺血性脑卒中 静脉溶栓 理想血压 围溶栓期 预后 

分 类 号：R74[医药卫生—神经病学与精神病学]