急性脑卒中降压治疗疗效评价

Therapeutic evaluation on lowering blood pressure of acute cerebral apoplexy

长期以来,关于急性脑卒中患者的血压是保持在高水平还是降至较低水平的问题一直存在争议。目前已有部分较大的循证医学证据支持脑卒中急性期降压治疗的获益,提示在急性缺血性或出血性卒中患者中积极降低血压是安全和有效的。但是,在那些重度急性脑卒中、颅内血流动力学不稳定患者中的降压仍需慎重,尚需大规模临床研究结果进一步证实。应在实际工作中根据患者的个体情况、综合分析降压过程的利弊。目前国内比较公认的意见是:血压>200/130 mmHg时开始降压治疗,24 h血压下降应<25%;溶栓前、溶栓后24 h内控制血压<185/110 mmHg。

For decades, controversy persists as to whether blood pressure should be maintained at a higher or lower level in subjects with acute stroke. A growing body of evidences has now supported the benefits of anti-hypertensive therapy in acute stroke, suggesting that aggressive control of blood pressure in acute ischemic or hemorrhagic stroke can be safe and effective. However, decision on anti-hypertensive approach in subjects with severe acute stroke or unstable intracranial hemodynamics should be made with caution and by far remains to be confirmed in large-scale clinical trials. The benefit and risk of anti-hypertensive therapy should be balanced on individual conditions of a patient and the outcomes of blood pressure. It is well-recognized among Chinese physicians that an- ti-hypertensive therapy should be given when blood pressure exceeds 200/130 mmHg with less than 25% reduction of the baseline blood pressure over 24 hours, and that a blood pressure of less than 185/110 mmHg should be obtained prior to and after thrombolytic treatment.