Optimal blood pressure levels in different phases of peripheral thrombolysis period in acute ischemic stroke
Optimal blood pressure levels in different phases of peripheral thrombolysis period in acute ischemic stroke
复制标题
急性缺血性脑卒中外周溶栓期不同阶段的最佳血压水平
DOI：
10.1097/hjh.0000000000002812
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发表时间：
2021-07-01
影响因子：
4.9
通讯作者：
Wang, Yibo
中科院分区：
文献类型：
--
作者：
He, Mingli;Wang, Hongrui;Wang, Yibo
背景：在外周溶栓期间观察到血压（BP）的急剧变化，然而，关于不同阶段的BP控制目标没有达成共识。方法：我们回顾性研究了连续样本的510例静脉溶栓治疗和随访3个月。外周溶栓期分为以下阶段：1期（从发病到溶栓）、2期（溶栓）、3期（从溶栓到溶栓后24 h）和4期（从溶栓后24h到7 d）。 根据这些阶段的平均血压，分别将患者分为五分之一。溶栓后3个月采用改良兰金量表评分评价神经功能改善情况。结果：SBP低五分位数组7天内发生脑出血的风险较低（1期五分位数Q1的OR= 0.100，95%CI 0.011-0.887，P =0.039; 2-3期五分位数Q1的OR= 0.110，95%CI 0.012-0.974，P =0.047; 4期五分位数Q2的OR，0.175，95%CI 0.035-0.872; P=0.033）。 在SBP五分位数中发现神经功能改善更好：4期研究中Q2-Q4（127.3-155.7 mmHg）（Q2的OR = 3.095，95% CI 1.524-6.286，P = 0.002; Q3的OR = 2.697，95% CI 1.354-5.370，P = 0.005; Q4的OR = 2.491，95% CI 1.263-4.913，P = 0.008）。 我们的研究结果还显示，在1期和2-3期研究中，SBP的平均真实的变异性较高与神经功能结局较好呈负相关。结论：从入院到溶栓后24 h内维持SBP水平（≤148 mmHg），然后维持SBP水平（127-138 mmHg）是有益的。
Supplemental Digital Content is available in the text Background: Dramatic changes of blood pressure (BP) were observed in the peripheral thrombolysis period, however, there is no consensus about BP control targets in the different phases. Methods: We retrospectively studied a consecutive sample of 510 patients treated with intravenous thrombolysis and followed-up for 3 months. The peripheral thrombolysis period was divided into these phases: Phase 1 (from onset to thrombolysis), Phase 2 (thrombolysis), Phase 3 (from thrombolysis to 24 h after thrombolysis), and Phase 4 (from 24 h to 7 days after thrombolysis). Patients were divided into quintiles according to mean blood pressure in these phases, respectively. Neurological improvement was evaluated using the modified Rankin Scale score at 3-month after thrombolysis. Results: Lower risk of intracerebral hemorrhage within 7 days was found in lower quintiles of SBP (OR = 0.100, 95% CI 0.011–0.887, P = 0.039 in Phase 1 quintile Q1, OR = 0.110, 95% CI 0.012–0.974, P = 0.047 in Phase 2–3 quintile Q1, and OR, 0.175, 95% CI, 0.035–0.872; P = 0.033 in Phase 4 quintile Q2, respectively). Better neurological improvement was found in SBP quintiles: Q2–Q4 (127.3–155.7 mmHg) in Phase 4 (OR = 3.095, 95% CI 1.524–6.286, P = 0.002 for Q2; OR = 2.697, 95% CI 1.354–5.370, P = 0.005 for Q3; and OR = 2.491, 95% CI 1.263–4.913, P = 0.008 for Q4, respectively). Our results also showed higher average real variability of SBP was negatively associated with better neurological outcome in Phase 1 and Phase 2–3. Conclusions: Maintaining SBP levels (≤148 mmHg) from admission to the first 24 h after thrombolysis, then keeping SBP levels (127–138 mmHg) would be beneficial.