早期血压升高对老年孤立性皮质下小梗死静脉溶栓后早期神经功能恶化的影响  

Effect of early elevated blood pressure on early neurological deterioration (END) after intravenous thrombolytic therapy for isolated small subcortical infarct (ISSI) in elderly patients

作　　者：鹿飞 赵建奇 Lu Fei;Zhao Jianqi(Department of Emergency,Second Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China)

机构地区：[1]徐州医科大学第二附属医院急诊科,徐州221006

出　　处：《中华急诊医学杂志》2024年第12期1720-1725,共6页Chinese Journal of Emergency Medicine

基　　金：徐州市重点研发计划项目(KC22206)。

摘　　要：目的探讨早期血压升高对静脉溶栓治疗老年孤立性皮质下小梗死(isolated small subcortical infarct,ISSI)后早期神经功能恶化(early neurological deterioration,END)的影响。方法连续纳入2018年6月至2022年12月期间于徐州医科大学第二附属医院急诊科进行静脉溶栓治疗的老年急性ISSI患者。END定义为静脉溶栓后24 h内复评美国国立卫生研究院中风量表(National Institutes of Health Stroke Scale,NIHSS)最高分较入院基线评分增加2分或2分以上。早期血压升高定义为静脉溶栓24 h内至少有一次出现收缩压高于静脉溶栓警戒值185 mmHg或舒张压高于警戒值110 mmHg。结果本研究总共纳入符合入组/排除标准的老年ISSI患者205例,其中47例(22.93%)患者在24 h内发生END,有88例(42.93%)患者静脉溶栓24 h内发生了早期血压升高现象。单因素分析显示,END患者和非END患者间年龄(P=0.032)、性别(P=0.028)、基线NIHSS评分(P<0.001)、糖尿病(P=0.026)、卒中前mRS评分≥2(P<0.001)、早期BP高于阈值比例(P=0.001)、SBP高于阈值比例(P<0.001)的比较,差异有统计学意义。进一步Logistic回归分析表明,早期BP高于阈值(OR=3.460,95%CI:1.604~7.465,P=0.002),SBP高于阈值(OR=3.619,95%CI:1.684~7.776,P=0.001)与END的发生独立相关。结论在老年急性ISSI患者中,静脉溶栓治疗后早期血压水平高于指南阈值较为常见,且与静脉溶栓治疗后24 h内END的发生独立相关。Aims To investigate the association of blood pressure(BP)excursions with early neurological deterioration(END)in patients with isolated small subcortical infarct(ISSI)treated with intravenous thrombolysis(IVT).Methods Consecutive patients with acute ISSI treated with IVT were prospectively registered from the Emergency Department,the Second Affiliated Hospital of Xuzhou Medical University between Jun 2018 and Dec 2022.END was defined as an NIHSS score increased≥2 during thefirst 24 hours compared with the initial NIHSS score.BP excursions,defined as greater than 185 systolic BP(SBP)or greater than 110 diastolic BP(DBP)were calculated and compared between patients with NED and those without(ED).Results A total of 205 patients with acute ISSI in the perforator territory of the MCA were included in this study.Of them,47(22.93%)patients developed END and 88(42.93%)patients had at least one BP excursion during thefirst 24 h following tPA bolus.Univariate analysis indicated that age,sex,baseline NIHSS,diabetes mellitus,previous mRS score≥2,BP excursion presence and SBP excursion presence significantly associated with the development of END(P<0.05).Logistic regression analyses indicated that BP excursion presence(OR=3.460,95%CI:1.604-7.465,P=0.002)and SBP excursion presence(OR=3.619,95%CI:1.684-7.776,P=0.001)were independently associated with END. Conclusions BP excursions above guideline thresholds during the first 24 h following IVT administration for ISSI is common and independently associated with END.

关 键 词：脑梗死 皮质下 静脉溶栓 早期神经功能恶化 血压 阈值 预后 病灶形态 

分 类 号：R743.3[医药卫生—神经病学与精神病学]