急性缺血性脑卒中血管内治疗后患者的早期血压管理的Meta分析  

Early blood pressure management after endovascular therapy foracute ischemic stroke: a Meta-analysis

作　　者：刘雪静 戴昕妤 郭欣雨 季国忠[1] 李云涛[1] LIU Xuejing;DAI Xinyu;GUO Xinyu;JI Guozhong;LI Yuntao(Department of General Practice,Second Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210011,China)

机构地区：[1]南京医科大学第二附属医院全科医学科,江苏南京210011

出　　处：《中国临床研究》2025年第3期398-403,共6页Chinese Journal of Clinical Research

基　　金：江苏省卫生健康委员会医学科研项目(M2022045)。

摘　　要：目的 对急性缺血性脑卒中患者血管内治疗后强化血压管理的安全性和有效性进行评估。方法 检索Pubmed、Embase、Web of Science、中国知网、万方数据库截止至2024年4月有关急性缺血性脑卒中血管内治疗后患者强化血压管理的研究。主要疗效结果是卒中发生3个月后的功能独立性[改良Rankin量表(mRS):0~2分]。次要疗效结果包括功能恢复良好(mRS:0~1分)、严重残疾(mRS:3~5分)和死亡或残疾(mRS:3~6分)。两个主要的安全性结果包括3个月内与本次卒中有关死亡的发生率和36小时内症状性颅内出血(sICH)的发生率。结果 在6项随机对照试验的1 739名患者中,与常规血压管理组相比,强化血压管理并不能显著提高功能独立性(RR=0.92, 95%CI:0.76~1.11;I^(2)=70%,P=0.39)。相反的是,强化降压会降低功能恢复(RR=0.87, 95%CI:0.76~0.99;I^(2)=11%,P=0.03),增加严重残疾(RR=1.42, 95%CI:1.21~1.68;I^(2)=0%,P<0.01)、死亡或残疾(RR=1.12, 95%CI:1.00~1.24;I^(2)=17%,P=0.04);在36小时内sICH (RR=1.07, 95%CI:0.75~1.54;I^(2)=0%,P=0.70)、3个月内与卒中相关的死亡(RR=1.13, 95%CI:0.88~1.45;I^(2)=0%,P=0.33)的风险上差异无统计学意义。结论 急性缺血性脑卒中患者血管内治疗后强化血压管理并未提高功能独立性和良好预后发生率,但却增加严重残疾、死亡或残疾的风险。因此,急性缺血性脑卒中患者血管内治疗后强化血压管理的获益有限。Objective To evaluate the safety and effectiveness of intensive blood pressure management after endovascular treatment(EVT)in patients with acute ischemic stroke(AIS).Methods The studies on intensive blood pressure management after EVT,in patients with AIS,were searched in PubMed,Embase,Web of Science,CNKI,and Wanfang Database,up to April 2024.The primary outcome was functional independence at 3 months after stroke[modified Rankin Scale(mRS):0-2 points].Secondary outcomes included good functional recovery(mRS:0-1 points),severe disability(mRS:3-5 points),and death or disability(mRS:3-6 points).The two primary safety outcomes included the incidence of death related to stroke within 3 months and the incidence of symptomatic intracranial hemorrhage(sICH)within 36 hours.Results Among 1739 patients in six randomized controlled trials,compared with the routine blood pressure management group,intensive blood pressure management did not significantly improve functional independence(RR=0.92,95%CI:0.76-1.11;I^(2)=70%,P=0.39).Conversely,intensive blood pressure reduction decreased functional recovery(RR=0.87,95%CI:0.76-0.99;I^(2)=11%,P=0.03),increased the risks of severe disability(RR=1.42,95%CI:1.21-1.68;I^(2)=0%,P<0.01),death or disability(RR=1.12,95%CI:1.00-1.24;I^(2)=17%,P=0.04),and there was no significant diffence in the risk of sICH within 36 hours(RR=1.07,95%CI:0.75-1.54;I^(2)=0%,P=0.70),and death related to stroke within 3 months(RR=1.13,95%CI:0.88-1.45;I^(2)=0%,P=0.33).Conclusion Intensive blood pressure management after EVT in patients with AIS does not improve the incidence of functional independence and good prognosis,but increases the risks of severe disability,death or diabilily.Therefore,the benefits of intensive blood pressure management after EVT in patients with AIS stroke are limited.

关 键 词：急性缺血性脑卒中 血管内治疗 血压管理 荟萃分析 改良Rankin量表 症状性颅内出血 

分 类 号：R743.32[医药卫生—神经病学与精神病学]