急性缺血性卒中血管内治疗围手术期血压管理研究进展(综述)

Advance in periprocedural blood pressure management of endovascular therapy in patients with acute ischemic stroke

围手术期血压可能影响急性缺血性卒中血管内治疗患者的预后,但由于血压监测方法、监测时机、基础血压、血管再通情况、麻醉方式等因素的不一致性,尚无统一指导意见。其中术前血压管理应在考虑患者发病机制的基础上遵循个体化原则;术中血压控制在某一稳定的水平对患者预后可能是有益的,但具体数值尚无定论;术后血压作为血压管理重点,血压的变异性应得到重视,血流达mTICI 2b级以上者应更积极降压,而mTICI在2b级以下者需谨慎降压,具体血压目标值尚需进一步研究。

Periprocedural blood pressure(BP)may affect functional outcomes of patients with acute ischemic stroke after endovascular treatment.However,there is no unified guidance of perioperative BP level at present due to the inconsistency of monitoring methods,monitoring timing,basal BP,differences of vascular recanalization,types of anesthesia and other factors.Preoperative BP management should follow the principle of individualization on the basis of patients'pathogenesis.Intraoperative BP control at a stable level may be beneficial to the patients'functional outcomes,but the specific targets are still inconclusive.Postoperative BP is the key point of the periprocedural BP management,and therefore we should pay attention to the variability of BP,be more active in lowering BP when recanalization status is deemed successful(mTICI 2b-3),and be cautious when recanalization is unsuccessful(mTICI 0-2a).But the BP targets need further evaluation in randomized studies.