急性缺血性脑卒中患者机械取栓术中血压变异性与不良预后的相关性研究  

Correlation study of blood pressure variability during mechanical thrombectomy and poor prognosis in patients with acute ischemic stroke

作　　者：李振东 管生[1] 韩坤强 司明磊 王林玉[1] LI Zhendong;GUAN Sheng;HAN Kunqiang;SI Minglei;WANG Linyu(The First Affiliated Hospital of Zhengzhou University,Zhenhzhou 450052,China)

机构地区：[1]郑州大学第一附属医院,河南郑州450052

出　　处：《中国实用神经疾病杂志》2021年第11期941-947,共7页Chinese Journal of Practical Nervous Diseases

基　　金：2020年度河南省高等学校重点科研项目(编号:20A320073)。

摘　　要：目的探讨急性缺血性脑卒中患者血管内治疗围手术期血压与预后的相关性。方法回顾性分析郑州大学第一附属医院神经介入科2019-01—2020-02收治的单侧前循环大血管闭塞导致的急性缺血性脑卒中患者92例,根据开通前软脑膜侧支代偿等级、开通后血流等级(mTICI)、90 d临床预后(mRS)分组,定义变异系数(coefficients of variation,CV)=(标准差/平均值)×100(CV=(SD/mean)×100),计算收缩压(SBP)、舒张压(DBP)、脉压(PP)、平均动脉压(MAP)的变异系数,即CV_(SBP)、CV_(DBP)、CV_(PP)、CV_(MAP),比较不同组间血压变异性。结果不同预后组CVPP存在明显差异(P=0.003),通过有序Logistic回归模型中粗略和校准优势比(ORs)的计算来评估基线变量和结果(3个月mRS)之间的相关性,发现CV_(PP)与不良的临床预后明显相关(未校准,OR=1.56,95%置信区间1.24~1.96,每增加1个单位,P′=0.0002;校准:OR=1.40,95%置信区间1.09~1.79,每增加1个单位,P=0.008)。结论机械取栓术(MT)中患者脉压的变异性(CV_(PP))与较差的临床结果独立相关,这些发现强调了密切监测血压的必要性,未来在机械取栓围手术期血压管理的指南中不仅要考虑血压的阈值,还要考虑血压的变异性。Objective To explore the correlation between perioperative blood pressure and prognosis of patients with acute ischemic stroke.Methods A retrospective analysis was performed on 92 patients with acute ischemic stroke who were admitted to the Department of Neuro-interventional Therapy,the First Affiliated Hospital of Zhengzhou University from January 2019 to February 2020 due to unilateral anterior circulation occlusion of the great vessels.The patients were divided into an array according to the grade of the pial collateral formation before opening,the blood flow grade after opening(mTICI),and the clinical prognosis(mRS)at 90 days.Then we defined the coefficients of variation(CV)=(standard deviation/average)×100(CV=(SD/mean)×100) and calculated the coefficients of systolic blood pressure(SBP),diastolic blood pressure(DBP),pulse pressure(PP)and average arterial blood pressure(MAP),namely CV_(SBP),CV_(DBP),CV_(PP)and CV_(MAP),blood pressure variability was compared between groups.Results CV_(PP)in different prognosis groups was significantly different(P=0.003).Correlations between baseline variables and outcomes(mRS at 3 months)were assessed using calculations of rough and adjusted odds ratios(ORs)in ordinal Logistic regression models,CV_(PP)was found to be significantly associated with poor clinical prognosis(rough,OR=1.56,95%confidence interval:1.24-1.96 per 1-unit increase;Adjusted,OR=1.40,95%confidence interval:1.09-1.79,P=0.008).Conclusion In conclusion,we observed that PP variability during MT was independently associated with worse clinical outcome in AIS patients.These findings emphasize the need for a close monitoring of BP.Future guidelines on BP management during MT should take into account not only SBP threshold but also BP variability.

关 键 词：急性缺血性脑卒中 大血管闭塞 血管内治疗 机械取栓术 血压变异参数 

分 类 号：R743.33[医药卫生—神经病学与精神病学]