急性缺血性脑卒中早期降压治疗对近期预后的影响

The Influence of Early Antihypertensive Treatment on Short-Term Prognosis of Acute Ischemic Stroke

目的:探讨早期降压治疗对急性缺血性脑卒中患者短期预后的影响。方法:连续纳入2018年3月至2021年2月于我院急诊高级卒中中心就诊的92例急性缺血性脑卒中患者,利用随机分组的方式将其分为早期降压组和标准血压管理组,每组各46例。早期降压组在入院后立即进行血压控制,24 h血压降低不超过20%,直至血压控制在正常范围并维持血压稳定。标准血压管理组在入院1周后启动降压治疗。动态监测两组患者入院后3个月内的神经功能缺损程度及临床疗效,包括入院后7 d、14 d、1个月、3个月的美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表评分变化,治疗总有效率,不良心血管事件发生情况,开展降压治疗对脑卒中近期预后的多因素Logistic回归分析。结果:两组患者入院后7 d、14 d、1个月、3个月的NIHSS评分、改良Rankin量表评分均呈降低趋势,而早期降压组患者神经功能恢复更明显(P<0.05);两组患者临床疗效比较,早期降压组优于标准血压管理组(P<0.05)。两组患者不良心血管事件发生率比较,差异有统计学意义(P<0.05)。本研究开展脑卒中预后的多因素分析,结果显示血压控制(OR=0.298,95%CI:0.134~0.726,P<0.05)和入院NIHSS评分是脑卒中患者近期预后的独立影响因素。结论:24 h内发病的急性期缺血性脑卒中患者接受早期降压治疗可以促进患者神经功能恢复,为患者预后提供保障,提高治疗效果。

Objective:To investigate the influence of early antihypertensive treatment on short-term prognosis of patients with acute ischemic stroke.Methods:A total of 92 patients with acute ischemic stroke admitted to the emergency advanced stroke center of our hospital from March 2018 to February 2021 were included,and were randomly divided into the early antihypertensive group and the standard blood pressure management group,with 46 cases in each group.The early antihypertensive group had blood pressure control immediately after admission,and the blood pressure were decreased by no more than 20%in 24 h until the blood pressure was controlled within the normal range and maintained stable.The standard blood pressure management group started antihypertensive treatment 1 week after admission.The degree of neurological deficit and clinical efficacy of the two groups of patients were dynamically monitored within 3 months after admission,including the changes of the National Institutes of Health Stroke Scale(NIHSS)score,the modified Rankin scale score,total therapeutic response rate and the incidence of adverse cardiac events at 7 d,14 d,1 month and 3 months after admission.Multivariate Logistic regression analysis of antihypertensive treatment on the short-term prognosis of stroke was carried out.Results:The NIHSS scores and modified Rankin scale scores of the two groups of patients at 7 d,14 d,1 month and 3 months after admission showed a decreasing trend,and the neurological function recovery of the patients in the early antihypertensive group was more obvious(P<0.05).The clinical efficacy of patients in the early antihypertensive group was better than that of the standard blood pressure management group(P<0.05).The incidence of adverse cardiac events of the two groups had statistical difference(P<0.05).The results of multivariate analysis of this study showed that blood pressure control(OR=0.298,95%CI:0.134-0.726,P<0.05)and NIHSS score on admission were the independent influencing factors of the short-term prognosis of stroke patients.Conclusion:This study showed that early antihypertensive treatment for acute ischemic stroke patients with onset within 24 h can promote the recovery of neurological function,provide guarantee for the prognosis of patients,and improve the treatment effect.