本文選題：血壓變異 + 腦梗死��； 參考：《第二軍醫(yī)大學(xué)學(xué)報(bào)》2016年10期

【摘要】：目的觀察急性缺血性腦卒中靜脈溶栓過(guò)程中血壓波動(dòng)幅度與患者預(yù)后的關(guān)系,以指導(dǎo)急性缺血性腦卒中超早期靜脈溶栓期間的血壓管理,提高急性缺血性腦卒中超早期治療的療效。方法選擇2013年9月至2015年12月在我院腦血管病中心診斷為急性缺血性腦卒中并在時(shí)間窗內(nèi)給予重組組織型纖溶酶原激活劑(rt-PA)靜脈溶栓的患者198例,其中男性125例、女性73例,年齡22~91歲,平均年齡(67.6±12.8)歲。根據(jù)NIHSS評(píng)分評(píng)價(jià)患者神經(jīng)系統(tǒng)功能缺損,采用改良Rankin量表(modified Rankin scale,mRS)評(píng)分評(píng)價(jià)患者預(yù)后。監(jiān)測(cè)靜脈溶栓開(kāi)始及溶栓過(guò)程中血壓變化水平,評(píng)估指標(biāo)包括均值(mean)、極大值(max)、極小值(min)、極差(max-min)、標(biāo)準(zhǔn)差(SD)、連續(xù)變異度(successive variation,SV)等。在各基線資料的校正下,懫用logistic回歸分析評(píng)估血壓參數(shù)對(duì)遠(yuǎn)期預(yù)后的影響。結(jié)果患者溶栓前NIHSS分值、發(fā)病至溶栓開(kāi)始的時(shí)間、平均溶栓前收縮壓(S0)、平均溶栓前脈壓(P0)以及在靜脈溶栓過(guò)程中最大收縮壓(Smax)、收縮壓連續(xù)變化(SSV)、最大收縮壓連續(xù)變化(SSVmax)、舒張壓最大值(Dmax)、舒張壓連續(xù)變化(DSV)、最大舒張壓連續(xù)變化(DSVmax)等為影響臨床結(jié)局的相關(guān)因素。多因素logistic回歸分析表明發(fā)病至治療時(shí)間短、溶栓前NIHSS評(píng)分低、溶栓前收縮壓值低,溶栓過(guò)程中連續(xù)的收縮壓及舒張壓血壓變異率低為預(yù)后良好的獨(dú)立預(yù)測(cè)因素。結(jié)論靜脈溶栓預(yù)后與溶栓開(kāi)始時(shí)的收縮壓、脈壓及溶栓過(guò)程中血壓變異率直接相關(guān)。血壓的變異率越大,即血壓的波動(dòng)越明顯,對(duì)預(yù)后越不利。維持穩(wěn)定的血壓有助于改善預(yù)后。
[Abstract]:Objective to observe the relationship between the fluctuation of blood pressure and the prognosis of patients with acute ischemic stroke during venous thrombolysis, so as to guide the management of blood pressure during ultra-early venous thrombolysis in acute ischemic stroke. To improve the effect of super early treatment for acute ischemic stroke. Methods 198 patients (125 males and 73 females) who were diagnosed as acute ischemic stroke in our cerebrovascular center from September 2013 to December 2015 and were given recombinant tissue plasminogen activator (rt-PA) intravenous thrombolytic therapy in the time window were selected. The average age was 67.6 鹵12.8 years. The neurological impairment was evaluated by NIHSS, and the prognosis was evaluated by modified Rankin scale. The changes of blood pressure were monitored at the beginning of intravenous thrombolytic therapy and during thrombolytic therapy. The evaluation indexes included mean, maximum value of max1, minimal value of minitron, extreme difference of max-mint, standard deviation of SDX, successive variability of SVV and so on. Logistic regression analysis was used to evaluate the effect of blood pressure parameters on long-term prognosis. Results the NIHSS score before thrombolysis, the time from onset to the beginning of thrombolysis, Mean systolic blood pressure before thrombolysis, pulse pressure before thrombolysis, and maximal systolic blood pressure during venous thrombolytic thrombolysis, continuous changes of systolic blood pressure (SSV), continuous variation of maximum systolic blood pressure, continuous variation of systolic blood pressure, maximum diastolic pressure, continuous variation of diastolic pressure, DSVV, maximum diastolic pressure, continuous variation of diastolic blood pressure, and continuous variation of diastolic blood pressure in the course of thrombolytic thrombolysis. Continuous changes in pressure and DSVmaxwere related factors to the clinical outcome. Multivariate logistic regression analysis showed that the short time from onset to treatment, the low score of NIHSS before thrombolysis, the low systolic blood pressure before thrombolysis, and the low variability rate of systolic blood pressure and diastolic blood pressure during thrombolysis were independent predictors of good prognosis. Conclusion the prognosis of intravenous thrombolysis is directly related to systolic blood pressure, pulse pressure and blood pressure variability during thrombolysis. The greater the variation rate of blood pressure, that is, the more obvious fluctuation of blood pressure, the more adverse to the prognosis. Maintaining stable blood pressure helps to improve prognosis.
【作者單位】： 第二軍醫(yī)大學(xué)長(zhǎng)海醫(yī)院腦血管病中心;
【基金】：上海市科委醫(yī)學(xué)引導(dǎo)項(xiàng)目(124119a8900) 上海申康醫(yī)院發(fā)展中心臨床管理優(yōu)化項(xiàng)目(SHDC2015607)~~
【分類號(hào)】：R743.33

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本文編號(hào)：1987138