Acute Blood Pressure Levels and Neurological Deterioration in Different Subtypes of Ischemic Stroke
Acute Blood Pressure Levels and Neurological Deterioration in Different Subtypes of Ischemic Stroke
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DOI：
10.1161/strokeaha.108.543587
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发表时间：
2009-07-01
期刊：
影响因子：
8.3
通讯作者：
Okada, Yasushi
中科院分区：
文献类型：
--
作者：
Toyoda, Kazunori;Fujimoto, Shigeru;Okada, Yasushi
背景和目的-本研究的目的是确定在缺血性卒中患者作为一个整体和不同亚型的患者中，在3周时急性血压（BP）与神经功能恶化相关的时间点。方法-在565例连续患者中，在紧急住院的前36小时内，每6小时测量一次BP（347名男性，70 +/- 11岁）在急性缺血性卒中24小时内出现。神经功能恶化定义为3周时美国国立卫生研究院卒中量表（NIHSS）评分较入院评分增加≥ 2分。结果3周时，64例患者（11.3%）神经功能恶化。对于整个组，在调整年龄、性别和已知的预测因素（包括入院时NIHSS评分、入院时血糖水平和大梗死面积）后，入院后12、18、24和36小时测量的高收缩压（SBP）值与神经功能恶化独立相关。在24小时，SBP每增加10 mm Hg，神经功能恶化的几率增加20%。对于心源性栓塞性中风患者，经过多变量调整后，12至36小时测量的高收缩压值与神经功能恶化独立相关。对于心源性栓塞以外的中风患者，任何时间点的SBP值均与神经功能恶化有关。结论急性SBP值在入院后12至36小时之间，但不是入院时或6小时，可预测缺血性中风最初3周内的神经功能恶化，特别是心源性栓塞性中风患者。（中风。2009; 40：2585-2588）。
Background and Purpose-The purpose of this study was to determine at which time points acute blood pressure (BP) was associated with neurological deterioration at 3 weeks in patients with ischemic stroke as a whole and in patients with different subtypes.Methods-BP was measured every 6 hours for the first 36 hours of emergent hospitalization in 565 consecutive patients (347 men, 70 +/- 11 years in age) presenting within 24 hours of an acute ischemic stroke. Neurological deterioration was defined as a >= 2-point increase in the National Institutes of Health stroke scale (NIHSS) score at 3 weeks compared to the admission score.Results-At 3 weeks, 64 patients (11.3%) had deteriorated neurologically. For the group as a whole, high systolic BP (SBP) values measured at 12, 18, 24, and 36 hours postadmission were independently related to neurological deterioration after adjustment for age, sex, and known predictors, including admission NIHSS score, admission blood glucose level, and large infarct size. At 24 hours, the odds of neurological deterioration increased by 20% per 10-mm Hg increase in SBP. For cardioembolic stroke patients, high SBP values measured at 12 through 36 hours were independently related to neurological deterioration after multivariate adjustment. For patients having stroke other than cardioembolism, no SBP values at any time point were related to neurological deterioration.Conclusions-Acute SBP values between 12 and 36 hours postadmission, but not those on admission or at 6 hours, were predictive of neurological deterioration within the initial 3 weeks of ischemic stroke, particularly for cardioembolic stroke patients. (Stroke. 2009; 40: 2585-2588.)