血压水平对急性缺血性脑卒中血管内治疗后脑灌注的影响

Effect of blood pressure level on cerebral perfusion after intravascular therapy in patients with acute ischemic stroke

目的探讨血压水平对急性缺血性脑卒中血管内治疗后脑灌注的影响。方法80例急性缺血性脑卒中合并高血压接受血管内治疗患者,随机分为积极降压组和指南降压组,每组40例。积极降压组在血管再通后1 h内将血压降至110~140/60~90 mm Hg(1 mm Hg=0.133 kPa)并至少维持72 h;指南降压组按照指南推荐将血压降至<180/110 mm Hg。比较两组患者性别、年龄、卒中部位、入院时的血压(收缩压/舒张压)情况、头颅影像学检查结果[脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)]、再通术后90 d美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分、吸烟史、饮酒史、糖尿病史、既往脑梗死病史和冠心病病史情况、病死率,分析脑灌注情况与血压、机械开通成功率、MTT、CBF的相关性。结果两组性别、年龄、卒中部位、病程、入院时血压(收缩压/舒张压)、吸烟史、饮酒史、糖尿病史、既往脑梗死病史和冠心病病史、病死率比较无差异(P>0.05)。积极降压组的机械开通成功率90.0%高于指南降压组的70.0%,头颅影像学检查结果MTT(35.12±2.63)s短于指南降压组的(41.99±2.56)s,CBF(65.72±3.50)ml/(100 g·min)、CBV(4.92±1.03)ml/100 g均大于指南降压组的(50.69±3.49)ml/(100 g·min)、(4.39±1.13)ml/100 g,再通术后90 d NIHSS评分(10.72±3.48)分低于指南降压组的(15.69±3.27)分,预后良好占比87.5%高于指南降压组的67.5%(P<0.05)。急性缺血性脑卒中患者脑灌注充分与否与血压水平呈负相关,与机械开通成功率、MTT、CBF呈正相关(P<0.05)。结论血压水平的控制范围会对急性缺血性脑卒中血管内治疗后脑灌注产生一定影响,而使用积极降压干预有助于改善患者预后,提高机械开通效果。

Objective To discuss the effect of blood pressure level on cerebral perfusion after intravascular therapy in patients with acute ischemic stroke.Methods 80 patients with acute ischemic stroke and hypertension were divided into active hypotensive group and guideline hypotensive group,with 40 patients in each group.In active hypotensive group,the blood pressure was reduced to 110-140/60-90 mm Hg(1 mm Hg=0.133 kPa)within 1 h after vascular recanalization and maintained for at least 72 h;in guideline hypotensive group,the blood pressure reduced to less than 180/110 mm Hg according to the guidelines.Gender,age,stroke location,blood pressure(systolic/diastolic blood pressure)at admission,results of head imaging examination[cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)],and National Institutes of Health Stroke Scale(NIHSS)score at 90 d after recalculation,modified Rankin Scale(mRS)score,smoking history,drinking history,diabetes history,previous history of cerebral infarction and coronary heart disease,and mortality were compared between the two groups,and the correlation between cerebral perfusion and blood pressure,success rate of mechanical opening,MTT,CBF was analyzed.Results Gender,age,stroke location,course of disease,blood pressure(systolic/diastolic blood pressure)at admission,smoking history,drinking history,previous history of cerebral infarction and coronary heart disease of the two groups showed no significant difference(P>0.05).In the active hypotensive group the success rate of mechanical opening of 90.0%was higher than 70.0%in the guideline hypotensive group;the MTT of(35.12±2.63)s was shorter than(41.99±2.56)s in the guideline hypotensive group;the CBF of(65.72±3.50)ml/(100 g·min)and CBV of(4.92±1.03)ml/100 g were higher than(50.69±3.49)ml/(100 g·min)and(4.39±1.13)ml/100 g in the guideline hypotensive group;the NIHSS score at 90 d after recanalization of(10.72±3.48)points was lower than(15.69±3.27)points in the guideline hypotensive group;the proportion of good prognosis of 87.5%was higher than 67.5%in the guideline hypotensive group(P<0.05).In patients with acute ischemic stroke,cerebral perfusion was negatively correlated with blood pressure,and positively correlated with success rate of mechanical opening,MTT and CBF(P<0.05).Conclusion The control range of blood pressure level will have a certain impact on cerebral perfusion after intravascular treatment of acute ischemic stroke,and the use of active hypotensive intervention will help improve the prognosis of patients and improve the mechanical opening effect.