入院血压对行血管内治疗的急性缺血性卒中患者神经功能预后的影响研究  

Effect of admission blood pressure on prognosis of neurological function in patients with acute ischemic stroke undergoing endovascular treatment

作　　者：武霄 宋海庆[1] 孙蔚 申慧鑫 寇凌泽 马青峰[1] 陈飞 黄小钦[1] Wu Xiao;Song Haiqing;Sun Wei;Shen Huixin;Kou Lingze;Ma Qingfeng;Chen Fei;Huang Xiaoqin(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053

出　　处：《中国脑血管病杂志》2022年第11期733-740,共8页Chinese Journal of Cerebrovascular Diseases

基　　金：国家重点研发计划(2016YFC0901004、2016YFC1300600);首都医科大学教育教学改革研究课题(2022JYY120);首都卫生发展科研专项(首发2020-2-2014)。

摘　　要：目的探讨血管内治疗的急性大血管闭塞性缺血性卒中患者入院血压与术后90 d神经功能预后之间的关系。方法回顾性分析2018年1月至2019年12月于首都医科大学宣武医院神经内科接受血管内治疗的急性大血管闭塞性卒中患者的基线资料[包括年龄、性别、体质量指数、血管危险因素、入院时即刻血压情况、卒中前改良Rankin量表(mRS)评分、美国国立卫生研究院卒中量表(NIHSS)评分、Alberta卒中项目早期CT评分、实验室检查结果及梗死部位(前循环、后循环)]以及血管内治疗相关信息(发病至治疗时间和闭塞血管再通程度)以及术后90 d神经功能预后、术后症状性颅内出血等。入院时记录基线收缩压和舒张压。闭塞血管再通评估采用改良脑梗死溶栓(mTICI)分级,术后90 d神经功能预后以mRS评估(mRS评分0~2分为预后良好,>2分为预后不良,其中6分为死亡),将所有患者依据术后90 d预后情况分为预后良好组与预后不良组。采用Spearman相关性分析方法评价入院血压与术后90 d mRS评分的关系,采用Logistic回归分析方法分析术后90 d时预后不良的影响因素。采用受试者工作特征(ROC)曲线评价入院血压对术后90 d预后不良的预测价值,依据截断值,将所有患者分成较高血压组(入院收缩压高于截断值)与较低血压组(入院收缩压低于截断值),分析不同收缩压患者的术后90 d mRS评分、良好预后比例及死亡情况。结果共入组369例患者,血管内治疗后血管再通322例(87.3%);术后症状性颅内出血62例(16.8%);术后90 d,137例(37.1%)患者预后良好,232例(62.9%)患者预后不良。入院收缩压与术后90 d神经功能预后相关(r=0.212,P<0.01)。预后不良组患者入院收缩压高于预后良好组[155(139,170)mmHg比142(130,162)mmHg,Z=-3.559,P<0.01]。Logistic回归分析结果显示,入院收缩压(OR=1.016,95%CI:1.005~1.028,P=0.004)、高脂血症病史(OR=0.550,95%CI:0.310~0.977,P=0Objective To investigate the relationship between admission blood pressure and 90 d neurological functional prognosis in patients with acute large-vessel occlusive ischemic stroke undergoing endovascular therapy.Methods From January 2018 to December 2019,acute large-vessel occlusive ischemic stroke patients who received endovascular therapy in the Department of Neurology of Xuanwu Hospital,Capital Medical University were recruited.Baseline data including age,gender,body mass index,vascular risk factors,blood pressure on admission,pre-morbid modified Rankin scale(mRS)score,the National Institutes of Health Stroke scale(NIHSS)score,the Alberta stroke project early CT score(ASPECTS),laboratory test results,infarction site(anterior circulation and posterior circulation),information related to endovascular therapy(time from onset to treatment and recanalization status),prognosis of neurological function at 90 days after surgery and postoperative symptomatic intracranial hemorrhage were retrospectively analyzed.Baseline systolic and diastolic blood pressure was recorded on admission.The modified thrombolysis in cerebral infarction(mTICI)was used to evaluate the recanalization status.The neurological outcome at 90 days after surgery was evaluated using the mRS(mRS score 0-2 was classified as good prognosis,>2 as poor prognosis,and 6 as death).All patients were divided into good prognosis group and poor prognosis group according to the prognosis at 90 days after operation.Spearman correlation analysis was used to evaluate the relationship between admission blood pressure and mRS score at 90 days after surgery,and Logistic regression analysis was used to analyze the influencing factors of poor prognosis at 90 days after surgery.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of admission blood pressure for poor prognosis at 90 days after surgery.According to the cut-off value,all patients were divided into high blood pressure group(admission systolic blood pressure higher than the cut

关 键 词：急性缺血性卒中 血管内治疗 功能预后 血压 

分 类 号：R743.3[医药卫生—神经病学与精神病学]