前循环机械取栓术后血压及血压变异性的研究进展

Progress in Blood Pressure and Blood Pressure Variability after Anterior Circulation Mechanical Thrombectomy

急性缺血性脑卒中(Acute Ischemic Stroke, AIS)是一种常见的神经系统疾病,可导致严重的长期残疾和死亡。及时、有效的血管再通至关重要,可明显改善预后。机械取栓术已经被证明是治疗AIS的一种新型方法,具有再通效率高、适应证广等优点,已成熟运用于前循环闭塞,且成为标准治疗术。2019年美国心脏协会/美国卒中协会(American Heart Association, AHA/American Stroke Association, ASA)指南建议接受机械取栓(Mechanical Thrombectomy, MT)治疗且未接受静脉溶栓(Intravenous Thrombolysis, IVT)的患者在手术过程中、MT术后24小时内和成功完成再灌注后控制血压 【180/105 mmHg (1 mmHg = 0.133 kPa)。有研究表明,再通后前24小时内保持相对较低的血压水平与良好的功能预后、降低死亡率和降低出血并发症相关。因此,把血压控制在一定范围至关重要。为更好地了解机械取栓术后的血压管理,通过对文献的阅读,对机械取栓术、AIS脑血流动力学、机械取栓术后的血压及术后的血压变异性作一综述。

Acute Ischemic Stroke (Acute Ischemic Stroke, AIS) is a common neurological disorder that causes severe long-term disability and death. Timely and effective vascular re-communication is crucial and can significantly improve the prognosis. Mechanical thrombectomy has been shown to be a new method for treating AIS, with the advantages of high recanalization efficiency and wide adaptation certificate, has been mature for anterior circulation occlusion, and has become the standard therapy. 2019 American Heart Association/American Stroke Association (American Heart Association, AHA/American Stroke Association, ASA) guidelines recommend acceptance of mechanical thrombectomy (Mechanical Thrombectomy, MT) was treated and did not receive intravenous thrombolysis (Intravenous Thrombolysis, IVT) in patients with blood pressure control <180/105 mmHg (1 mmHg = 0.133 kPa during surgery, within 24 hours after MT, and after successful completion of reperfusion). It has been shown that maintaining relatively low BP levels during the first 24 h after recanalization is associated with good functional prognosis, reduced mortality, and reduced bleeding complications. Therefore, it is crucial to control blood pressure in a certain range. In order to better understand the blood pressure management after mechanical thrombectomy, mechanical thrombectomy, AIS cerebral hemodynamics, mechanical thrombectomy and postoperative blood pressure variability were reviewed through the reading of the literature.