A pilot randomized trial of induced blood pressure elevation: Effects on function and focal perfusion in acute and subacute stroke
A pilot randomized trial of induced blood pressure elevation: Effects on function and focal perfusion in acute and subacute stroke
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DOI：
10.1159/000071122
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发表时间：
2003-01-01
影响因子：
2.9
通讯作者：
Wityk, RJ
中科院分区：
文献类型：
--
作者：
Hillis, AE;Ulatowski, JA;Wityk, RJ
背景小型非随机研究表明，脑卒中诱导的血压升高可能改善缺血性卒中的功能，可能是通过改善缺血但非梗死组织的血流（可能由MRI上的扩散-灌注不匹配指示）。我们进行了一项初步的随机试验，以评估在急性卒中中，高血压引起的血压升高对功能和灌注的影响。研究方法：连续系列的大弥散-灌注不匹配的患者被随机分配到诱导血压升高组（“治疗”患者，n = 9）或常规治疗组（“未治疗”患者，n = 6）。结果：基线时两组之间无显著差异。在第3天（平均值5.6 vs. 12.3; p = 0.01）和第6-8周（平均值2.8 vs. 9.7; p < 0.04），治疗组与未治疗组相比，NIH卒中量表（NIHSS）评分较低（较好）。从第1天到第3天，接受治疗（但未接受治疗）的患者在NIHSS评分（从平均10.2到5.6; p < 0.002）、认知评分（从平均58.7到27.9%错误; p < 0.002）和低灌注组织体积（从平均132到58 ml; p < 0.02）方面表现出显著改善。平均动脉压（MAP）和日常认知测试准确性之间的高Pearson相关性表明，功能变化是由于MAP的变化。结论：结果证明了一项全面的、双盲的临床试验，以评估在选择性急性/亚急性卒中患者中诱导血压升高的疗效和风险。版权所有（C）2003 S. Karger AG，巴塞尔。
Background. Small, unrandomized studies have indicated that pharmacologically induced blood pressure elevation may improve function in ischemic stroke, presumably by improving blood flow to ischemic, but non-infarcted tissue (which may be indicated by diffusion-perfusion mismatch on MRI). We conducted a pilot, randomized trial to evaluate effects of pharmacologically induced blood pressure elevation on function and perfusion in acute stroke. Methods: Consecutive series of patients with large diffusion-perfusion mismatch were randomly assigned to induced blood pressure elevation ('treated' patients, n = 9) or conventional management ('untreated' patients, n = 6). Results: There were no significant differences between groups at baseline. NIH Stroke Scale (NIHSS) scores were lower (better) in treated versus untreated patients at day 3 (mean 5.6 vs. 12.3; p = 0.01) and week 6-8 (mean 2.8 vs. 9.7; p < 0.04). Treated (but not untreated) patients showed significant improvement from day 1 to day 3 in NIHSS score (from mean 10.2 to 5.6; p < 0.002), cognitive score (from mean 58.7 to 27.9% errors; p < 0.002), and volume of hypoperfused tissue (mean 132 to 58 ml; p < 0.02). High Pearson correlations between the mean arterial pressure (MAP) and accuracy on daily cognitive tests indicated that functional changes were due to changes in MAP. Conclusion: Results warrant a full-scale, double-blind clinical trial to evaluate the efficacy and risk of induced blood pressure elevation in selective patients with acute/subacute stroke. Copyright (C) 2003 S. Karger AG, Basel.