早期强化降压对急性缺血性脑卒中静脉溶栓患者出血转化及认知功能的影响  

Effect of early intensive antihypertension on hemorrhage transformation and cognitive function in patients with acute ischemic stroke after intravenous thrombolysis

作　　者：叶佳媚[1] 李辉军[2] 黄阳萍 林青[1] YE Jiamei;LI Huijun;HUANG Yangping;LIN Qing(Department of Neurology,Taizhou First People′s Hospital,Taizhou 318020,China;Department of Ophthalmology,Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University,Taizhou 317000,China)

机构地区：[1]台州市第一人民医院神经内科,浙江台州318020 [2]浙江省台州医院眼科,浙江台州317000

出　　处：《中国现代医生》2022年第12期31-33,38,共4页China Modern Doctor

基　　金：浙江省卫生健康科技计划项目(2021KY1211)。

摘　　要：目的探讨早期强化降压对急性缺血性脑卒中静脉溶栓患者出血转化及认知功能的影响。方法选取2019年2月至2020年5月台州市第一人民医院收治的行静脉溶栓的急性缺血性脑卒中患者186例,按照降压方式分为对照组与研究组,每组各93例,对照组患者常规降压,研究组患者给予强化降压干预。对比两组患者的收缩压、舒张压、GFAP、IGF-1水平、出血转化情况;使用MoCA量表对患者认知功能进行评价;使用90 d改良Rankin量表评价患者预后情况。结果溶栓后两组患者的收缩压、舒张压均下降,且研究组的收缩压、舒张压较低(P<0.05);溶栓后患者GFAP水平下降,IGF-1水平上升,且研究组GFAP水平较低,IGF-1水平较高(P<0.05);两组出血性梗死率比较,差异无统计学意义(P>0.05);两组脑实质性出血率比较,差异有统计学意义(P<0.05);溶栓后研究组MoCA评分较高,差异有统计学意义(P<0.05);使用90 d mRS量表对患者预后情况进行检测发现,研究组评分情况与对照组比较,差异无统计学意义(P>0.05)。结论使用早期强化降压对急性缺血性脑卒中静脉溶栓患者进行干预,能有助于减少出血转化的风险,改善认知能力,有着较高的预后效果。Objective To investigate the effect of early intensive antihypertension on hemorrhage transformation and cognitive function in patients with acute ischemic stroke after intravenous thrombolysis.Methods A total of 186 acute ischemic stroke patients who were treated with intravenous thrombolysis from February 2019 to May 2020 in Taizhou First People′s Hospital were selected,and they were divided into the control group and the study group according to the hypotensive method,with 93 patients in each group.The control group was treated with routine hypotensive intervention,and the study group was treated with intensive hypotensive intervention.The systolic blood pressure,diastolic blood pressure,GFAP,IGF-1 levels and bleeding transformation were compared between the two groups.The MoCA scale was used to evaluate the cognitive function of the patients.Patients′prognosis was evaluated by using the 90 d modified Rankin scale.Results After the thrombolytic therapy,the systolic blood pressure and diastolic blood pressure in both groups were decreased,and the systolic blood pressure and diastolic blood pressure in the study group were lower(P<0.05).After the thrombolytic therapy,the levels of GFAP were decreased and the levels of IGF-1 were increased,and the levels of GFAP were decreased and the levels of IGF-1 were higher in the study group(P<0.05).No significant difference was observed in the rate of hemorrhagic infarction between the two groups(P>0.05).The substantive cerebral hemorrhage rate was compared between the two groups(P<0.05).The MoCA score was higher in the study group after thrombolytic therapy(P<0.05).The 90 dm RS scale was used to test the prognosis of patients,and no statistical difference was observed between the scores of the study group and the control group(P>0.05).Conclusion Early intensive antihypertensive intervention in patients with acute ischemic stroke with intravenous thrombolysis can help reduce the risk of hemorrhage transformation,improve cognitive ability,and have a high prognostic effe

关 键 词：早期强化降压 急性缺血性脑卒中 静脉溶栓 出血转化 

分 类 号：R737.9[医药卫生—肿瘤]