本文選題：缺血性卒中 + 靜脈溶栓治療　； 參考：《浙江大學(xué)》2015年博士論文

【摘要】：研究目的： 高血壓是卒中的獨(dú)立風(fēng)險(xiǎn)因素之一。越來越多的研究顯示,血壓變異在卒中的發(fā)生及預(yù)后中起重要作用。本研究探討缺血性卒中靜脈溶栓后早期血壓變異與出血轉(zhuǎn)化、組織再灌及遠(yuǎn)期預(yù)后之間的關(guān)系。 研究方法： 回顧性分析2009年6月至2014年10月本院接受靜脈溶栓治療的急性缺血性卒中患者的臨床及影像學(xué)資料。監(jiān)測(cè)靜脈溶栓后24小時(shí)內(nèi)每小時(shí)血壓值,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),極差值(max-min),標(biāo)準(zhǔn)差(SD),連續(xù)變異度(successive variation, SV),血壓升值連續(xù)變異度(SVrise)與最大升值變異(SVmaXrise),血壓降值連續(xù)變異度(SVdrop)與最大降值變異(SVmaxdrop)。根據(jù)歐洲急性卒中二期試驗(yàn)(The Second European Cooperative Acute Stroke Study, ECASS-Ⅱ),將出血轉(zhuǎn)化分為滲血型(hemorrhagic infarction, HI)和血腫型(parenchymal hematoma, PH),將癥狀性出血定義為美國國立衛(wèi)生研究所腦卒中評(píng)分標(biāo)準(zhǔn)(the National Institute of Health Stroke Scale, NIHSS)評(píng)分≥4分或致死的出血轉(zhuǎn)化。根據(jù)磁共振灌注影像,將達(dá)峰時(shí)間(Tmax)6秒定義為低灌區(qū),以24小時(shí)復(fù)查復(fù)灌率50%定義為再灌。將3月改良Rankin評(píng)分(mRS)≥2分定義為遠(yuǎn)期預(yù)后不良。在各基線資料的校正下,采用logistic回歸分析血壓參數(shù)對(duì)出血轉(zhuǎn)化、癥狀性出血、再灌和遠(yuǎn)期預(yù)后的影響。 研究結(jié)果： 461例患者納入出血、預(yù)后分析,其中142(30.8%)例患者發(fā)生出血轉(zhuǎn)化,出血分型如下：36(7.8%)例HI-1型,63(13.7%)例HI-2型,19(4.1%)例PH-1型,24(5.2%)例PH-2型。12(2.6%)例患者發(fā)生癥狀性出血。96例患者納入再灌分析,其中57(59.4%)達(dá)到再灌。多因素分析校正后,靜脈溶栓后24小時(shí)內(nèi)收縮壓(SBP) SD (每10%,OR=1.994,95%CI:1.05-3.78, p=0.033),SV(每10%, OR=2.322,95%CI:1.09-4.93, p=0.028), SVmaxrise(每10mmHg, OR=1.321,95%CI:1.01-1.72, p=0.040)為PH型出血的獨(dú)立風(fēng)險(xiǎn)因素。SBP極差值(每1OmmHg, OR=1.340,95%CI:1.06-1.69, p=0.014), SD(每10%, OR=4.538,95%CI:1.83-11.23, p=0.001), SV(每10%, OR=6.117,95%CI:2.00-18.71, p=0.002), SVmaxrise(每10mmHg, OR=1.574,95%CI:1.05-2.36, p=0.029)為癥狀性出血的獨(dú)立風(fēng)險(xiǎn)因素。收縮壓均值(每10mmHg, OR=1.344,95%CI:1.15-1.57, p0.001),極大值(每10mmHg,OR=1.266,95%CI:1.12-1.42, p0.001),極小值(每1OmmHg, OR=1.196,95%CI:1.02-1.40, p0.001),極差值(每10mmHg, OR=1.209,95%CI:1.05-1.39, p=0.008),SD(每10%,OR=1.882,95%CI:1.06-3.33, p=0.030), SV(每10%,OR=3.998,95%CI:2.20-7.26, p0.001), SVmaxrise(每10mmHg, OR=1.618,95%CI:1.29-2.01, p0.001), SVmaxdrop(每10mmHg, OR=1.389,95%CI:1.13-1.69, p=0.001)是遠(yuǎn)期預(yù)后不良的獨(dú)立風(fēng)險(xiǎn)因素。靜脈溶栓后6小時(shí)內(nèi)收縮壓SVrise越高,患者再灌可能性越低(每10%, OR=0.922,95%CI:0.86-0.99, p=0.025)。 研究結(jié)論： 收縮壓變異度是預(yù)測(cè)急性缺血性卒中患者靜脈溶栓后發(fā)生PH型出血、癥狀性出血的獨(dú)立危險(xiǎn)因素,而收縮壓均值水平和變異度均為遠(yuǎn)期預(yù)后不良的獨(dú)立危險(xiǎn)因素。靜脈溶栓后超早期收縮壓正向波動(dòng)大,患者不易再灌。
[Abstract]:Objectives of the study: Hypertension is one of the independent risk factors for stroke. More and more studies show that blood pressure variation plays an important role in the occurrence and prognosis of stroke. The purpose of this study was to investigate the relationship between early blood pressure variation, hemorrhage transformation, tissue reperfusion and long term prognosis after intravenous thrombolysis in ischemic stroke. Research methods: The clinical and imaging data of patients with acute ischemic stroke treated with intravenous thrombolysis from June 2009 to October 2014 were retrospectively analyzed. Blood pressure was monitored within 24 hours after intravenous thrombolysis. The evaluation indexes of blood pressure change level include mean value, maximum value, minimum value, extremely difference value, standard deviation, successive variation, continuous variability, continuous variation of blood pressure appreciation, and maximum value of appreciation, continuous variation and continuous variation of blood pressure drop value (SVdrop1) and maximum drop value variation of SVmax dropper. According to the Second European Cooperative Acute Stroke Study, ECASS- 鈪，

本文編號(hào)：1958518