不同类型脑梗死患者急性期血压调控对预后的影响

Influence of early blood pressure control on the prognosis of different ischemic stroke subtypes

目的本研究旨在阐述脑梗死急性期患者降压治疗的必要性及对预后的影响。方法收集急性期脑梗死患者157例,按TOAST分型:大动脉粥样硬化型,心源性栓塞型,腔隙性梗死型,其他原因及不明原因型。按OCSP分类:完全前循环型梗死,部分前循环型梗死,腔隙性梗死,后循环型梗死。各亚型患者再分为血压干预组及未干预组,记录患者入院时、治疗1周后及随访6个月后的NIHSS评分、Barthel index评分及Rankin评分。结果入院时,SA患者Barthel index评分明显高于CE患者。POCI患者及TACI患者Barthel index评分明显高于LACI患者。发病6个月后,CE、LVA和POCI患者血压未干预组Barthel index评分较干预组高。结论急性脑梗死患者过于积极地血压干预治疗对预后不利,尤其是CE,LVA和POCI患者发病急性期降压治疗对远期预后可产生不良影响。

Objective To clarify the prognostic differences of early blood pressure control among different ischemic stroke subtypes.Methods The data of 157 patients in acute ischemic stroke were collected,and were assessed with the Trial of Org 10172 in Acute Stroke Treatment（TOAST） classification： large-vessel atherothrombotic（LVA）,cardioembolic（CE）,small-vessel and lacunar infarct（SA） and Stroke of Other Determined Etiology Stroke of undetermined cause（SOD SUD）.All of the patients were also assessed with the Oxfordshire Community Stroke Project（OCSP）： total anterior circulation infarct（TACI）,partial anterior circulation infarct（PACI）,LACI,posterior circulation infarct（POCI）.The blood pressure levels during the initial 7 hospital days were monitored.All the patients of subtype were divided into two groups： BP uncontrolled group and BP controlled group.And the prognostic factors were assessed by NIHSS,Barthel index and Rankin at the first and 7th hospital day,and 6 month after infarction onset.Results On admission,Barthel index scores of SA patients were higher than those of CE patients.Barthel index scores of POCI and TACI patients were higher than those of LACI patients.Six month after cerebral infarction onset,patients without antihypertension treatment of CE,LVA and POCI had higher Barthel index scores than those with antihypertension treatment.Conclusion We shouldn＇t adopt excessive antihypertension measures in acute cerebral ischemic stroke,especially for CE,LVA and POCI patients,because excessive antihypertension treatment will result in poor prognosis for long.