背景高血压是急性脑卒中的预后因子，血压变异性或许可以独立预测脑卒中的转归。我们评估了血压变异性对INTERACT2参试者脑卒中预后的预测价值， INTERACT2是一项开放标签随机对照试验。方法 INTERACT2将患有自发性颅内出血（ICH）、高...背景高血压是急性脑卒中的预后因子，血压变异性或许可以独立预测脑卒中的转归。我们评估了血压变异性对INTERACT2参试者脑卒中预后的预测价值， INTERACT2是一项开放标签随机对照试验。方法 INTERACT2将患有自发性颅内出血（ICH）、高收缩压（150～220 mm Hg）、对早期降压强化疗法无明确适应证或禁忌证的2839例成人纳入研究。将患者随机分为强化治疗组（经静脉给药，1 h内目标收缩压降至＜140 mm Hg ）和指南推荐的治疗组（ ICH 后6 h 内，目标收缩压降至＜180 mm Hg）。主要转归为死亡或90 d内发生生活大部分无法自理（改良Rankin量表评分≥3分）；次要转归为90 d内改良Rankin量表评分发生顺序移动，调查员在评分时并不知晓患者接受了哪种治疗。根据标准定义血压变异性：在发病头24 h （超急性期）进行5次测量，在发病后2～7 d （急性期）进行不少于12次的测量。采用比例优势逻辑回归模型评价血压变异性与转归之间的关联。血压变异性关键指标为收缩压的标准差，按五分位数加以分类。发现研究者对2645例（93.2％）处于超急性期的患者和2347例（82.7％）处于急性期的患者进行了调查。将两个治疗组的数据一起分析，在超急性期〔最高五分位数校正OR＝1.41，95％CI （1.05，1.90）； P＝0.0167〕和急性期〔最高五分位数校正OR＝1.57，95％CI （1.14，2.17）； P＝0.0124〕，收缩压的标准差与主要转归均呈线性相关。对转归最强的预测指标为超急性期最高收缩压和急性期收缩压的标准差为结果的最强预示因子。对次要转归进行分析，得到的结果与以上结果相似〔超急性期最高五分位数，校正OR＝1.43，95％CI （1.14，1.80）； P＝0.0014；急性期OR＝1.46，95％CI （1.13，1.88）； P＝0.0044〕。解释收缩压变异性似乎可预测急性颅内出血患者的不良转归。早期治疗将收缩压降至140 mm Hg以下获得的收益，可通过平稳并持续血压控制进行强化，避免出现收缩压峰值尤为重要。展开更多
急性颅内出血（ICH）时,若血压升高则与其血肿扩散、神经功能退变等诸不良预后明显有关,而降压治疗则可降低诸种风险。然而降压过程中可能存在每日血压变异,迄今关于每日血压变异与接受降压治疗的急性ICH近期不良预后间关系尚不清楚,现...急性颅内出血（ICH）时,若血压升高则与其血肿扩散、神经功能退变等诸不良预后明显有关,而降压治疗则可降低诸种风险。然而降压过程中可能存在每日血压变异,迄今关于每日血压变异与接受降压治疗的急性ICH近期不良预后间关系尚不清楚,现就此进行分析。受试对象为205例急性ICH患者,平均年龄65岁。均于急性ICH超急期（发病〈3 h内）接受降压治疗,且初始收缩压（SBP）均〉180 mm Hg（1 mm Hg=0.133 3 k Pa）,展开更多
BACKGROUND: Intracerebral hemorrhage is the least treatable form of stroke and is associated with high mortality.Among patients who undergo computed tomograph y (CT) within three hours after the onset of intracerebral...BACKGROUND: Intracerebral hemorrhage is the least treatable form of stroke and is associated with high mortality.Among patients who undergo computed tomograph y (CT) within three hours after the onset of intracerebral hemorrhage, one third have an increase in the volume of the hematoma related to subsequent bleeding. We sought to determine whether recombinant activated factor VII (rFVIIa) can red uce hematoma growth after intracerebral hemorrhage. METHODS: We randomly assigne d 399 patients with intracerebral hemorrhage diagnosed by CT within three hours after onset to receive placebo (96 patients) or 40 μg of rFVIIa per kilogram of body weight (108 patients), 80 μg per kilogram (92 patients), or 160 μg per k ilogram (103 patients) within one hour after the baseline scan. The primary outc ome measure was the percent change in the volume of the intracerebral hemorrhage at 24 hours. Clinical outcomes were assessed at 90 days. RESULTS: Hematoma volu me increased more in the placebo group than in the rFVIIa groups. The mean incre ase was 29 percent in the placebo group, as compared with 16 percent, 14 percent , and 11 percent in the groups given 40 μg, 80 μg, and 160 μg of rFVIIa per k ilogram, respectively (P=0.01 for the comparison of the three rFVIIa groups with the placebo group). Growth in the volume of intracerebral hemorrhage was reduce d by 3.3 ml, 4.5 ml, and 5.8 ml in the three treatment groups, as compared with that in the placebo group (P=0.01). Sixty-nine percent of placebo-treated pati ents died or were severely disabled (as defined by a modified Rankin Scale score of 4 to 6), as compared with 55 percent, 49 percent, and 54 percent of the pati ents who were given 40, 80, and 160 μg of rFVIIa, respectively (P=0.004 for the comparison of the three rFVIIa groups with the placebo group). Mortality at 90 days was 29 percent for patients who received placebo, as compared with 18 perce nt in the three rFVIIa groups combined (P=0.02). Serious thromboembolic adverse events, mainly myocardial or cerebral infarction, occurred in 7 percent of rFVII a-treated patients, as compared with 2 percent of those given placebo (P=0.12). CONCLUSIONS:Treatment with rFVIIa within four hours after the onset of intracer ebral hemorrhage limits the growth of the hematoma, reduces mortality, and impro ves functional outcomes at 90 days, despite a small increase in the frequency of thromboembolic adverse events.展开更多
文摘背景高血压是急性脑卒中的预后因子，血压变异性或许可以独立预测脑卒中的转归。我们评估了血压变异性对INTERACT2参试者脑卒中预后的预测价值， INTERACT2是一项开放标签随机对照试验。方法 INTERACT2将患有自发性颅内出血（ICH）、高收缩压（150～220 mm Hg）、对早期降压强化疗法无明确适应证或禁忌证的2839例成人纳入研究。将患者随机分为强化治疗组（经静脉给药，1 h内目标收缩压降至＜140 mm Hg ）和指南推荐的治疗组（ ICH 后6 h 内，目标收缩压降至＜180 mm Hg）。主要转归为死亡或90 d内发生生活大部分无法自理（改良Rankin量表评分≥3分）；次要转归为90 d内改良Rankin量表评分发生顺序移动，调查员在评分时并不知晓患者接受了哪种治疗。根据标准定义血压变异性：在发病头24 h （超急性期）进行5次测量，在发病后2～7 d （急性期）进行不少于12次的测量。采用比例优势逻辑回归模型评价血压变异性与转归之间的关联。血压变异性关键指标为收缩压的标准差，按五分位数加以分类。发现研究者对2645例（93.2％）处于超急性期的患者和2347例（82.7％）处于急性期的患者进行了调查。将两个治疗组的数据一起分析，在超急性期〔最高五分位数校正OR＝1.41，95％CI （1.05，1.90）； P＝0.0167〕和急性期〔最高五分位数校正OR＝1.57，95％CI （1.14，2.17）； P＝0.0124〕，收缩压的标准差与主要转归均呈线性相关。对转归最强的预测指标为超急性期最高收缩压和急性期收缩压的标准差为结果的最强预示因子。对次要转归进行分析，得到的结果与以上结果相似〔超急性期最高五分位数，校正OR＝1.43，95％CI （1.14，1.80）； P＝0.0014；急性期OR＝1.46，95％CI （1.13，1.88）； P＝0.0044〕。解释收缩压变异性似乎可预测急性颅内出血患者的不良转归。早期治疗将收缩压降至140 mm Hg以下获得的收益，可通过平稳并持续血压控制进行强化，避免出现收缩压峰值尤为重要。
文摘急性颅内出血（ICH）时,若血压升高则与其血肿扩散、神经功能退变等诸不良预后明显有关,而降压治疗则可降低诸种风险。然而降压过程中可能存在每日血压变异,迄今关于每日血压变异与接受降压治疗的急性ICH近期不良预后间关系尚不清楚,现就此进行分析。受试对象为205例急性ICH患者,平均年龄65岁。均于急性ICH超急期（发病〈3 h内）接受降压治疗,且初始收缩压（SBP）均〉180 mm Hg（1 mm Hg=0.133 3 k Pa）,
文摘BACKGROUND: Intracerebral hemorrhage is the least treatable form of stroke and is associated with high mortality.Among patients who undergo computed tomograph y (CT) within three hours after the onset of intracerebral hemorrhage, one third have an increase in the volume of the hematoma related to subsequent bleeding. We sought to determine whether recombinant activated factor VII (rFVIIa) can red uce hematoma growth after intracerebral hemorrhage. METHODS: We randomly assigne d 399 patients with intracerebral hemorrhage diagnosed by CT within three hours after onset to receive placebo (96 patients) or 40 μg of rFVIIa per kilogram of body weight (108 patients), 80 μg per kilogram (92 patients), or 160 μg per k ilogram (103 patients) within one hour after the baseline scan. The primary outc ome measure was the percent change in the volume of the intracerebral hemorrhage at 24 hours. Clinical outcomes were assessed at 90 days. RESULTS: Hematoma volu me increased more in the placebo group than in the rFVIIa groups. The mean incre ase was 29 percent in the placebo group, as compared with 16 percent, 14 percent , and 11 percent in the groups given 40 μg, 80 μg, and 160 μg of rFVIIa per k ilogram, respectively (P=0.01 for the comparison of the three rFVIIa groups with the placebo group). Growth in the volume of intracerebral hemorrhage was reduce d by 3.3 ml, 4.5 ml, and 5.8 ml in the three treatment groups, as compared with that in the placebo group (P=0.01). Sixty-nine percent of placebo-treated pati ents died or were severely disabled (as defined by a modified Rankin Scale score of 4 to 6), as compared with 55 percent, 49 percent, and 54 percent of the pati ents who were given 40, 80, and 160 μg of rFVIIa, respectively (P=0.004 for the comparison of the three rFVIIa groups with the placebo group). Mortality at 90 days was 29 percent for patients who received placebo, as compared with 18 perce nt in the three rFVIIa groups combined (P=0.02). Serious thromboembolic adverse events, mainly myocardial or cerebral infarction, occurred in 7 percent of rFVII a-treated patients, as compared with 2 percent of those given placebo (P=0.12). CONCLUSIONS:Treatment with rFVIIa within four hours after the onset of intracer ebral hemorrhage limits the growth of the hematoma, reduces mortality, and impro ves functional outcomes at 90 days, despite a small increase in the frequency of thromboembolic adverse events.
