中国实用神经疾病杂志
中國實用神經疾病雜誌
중국실용신경질병잡지
CHINESE JOURNAL OF PRACTICAL NERVOUS DISEASES
2015年
3期
5-7
,共3页
王大力%花楠%彭延波%张江
王大力%花楠%彭延波%張江
왕대력%화남%팽연파%장강
脑梗死%高血压%降压治疗%预后%死亡%残疾%复发
腦梗死%高血壓%降壓治療%預後%死亡%殘疾%複髮
뇌경사%고혈압%강압치료%예후%사망%잔질%복발
Brain infarction%Hypertension%Antihypertensive therapy%Prognosis%Death%Major disability%Recurrent
目的：探讨脑梗死急性期降压治疗与3个月预后的关系，为急性脑梗死患者血压管理提供依据。方法将入选的452例急性脑梗死患者依据发病前2周内是否服用降压药物分为2个亚组，将两亚组随机分为干预组和对照组。干预组给予降压治疗[入院24 h内收缩压（SBP）下降10％～20％，7～14 d血压140／90 mmHg（1 mmHg＝0.133 kPa）以下]，对照组不降压。动态监测所有患者14 d内的血压变化，并记录入院时基本资料及3个月死亡／主要残疾及复发等情况。结果2个亚组中，干预组和对照组死亡／残疾比率差异均无统计学意义（P＞0.05），只有在近期服用降压药物患者中，干预组复发率明显低于对照组（P＜0.05），而在近期未服用降压药物患者中，2组复发率无明显差别（P＞0.05）。分别对两亚组患者进行多因素Logistic回归分析显示，在调整年龄、高血压史、入院SBP、入院NIHSS评分、3个月SBP及3个月内服用降压药情况等因素后，急性期降压治疗均不影响急性脑梗死3个月预后。结论脑梗死患者急性期给予适度降压治疗不能增加或降低3个月死亡／致残和复发的风险，所以血压管理需依据病情实行个体化原则。
目的：探討腦梗死急性期降壓治療與3箇月預後的關繫，為急性腦梗死患者血壓管理提供依據。方法將入選的452例急性腦梗死患者依據髮病前2週內是否服用降壓藥物分為2箇亞組，將兩亞組隨機分為榦預組和對照組。榦預組給予降壓治療[入院24 h內收縮壓（SBP）下降10％～20％，7～14 d血壓140／90 mmHg（1 mmHg＝0.133 kPa）以下]，對照組不降壓。動態鑑測所有患者14 d內的血壓變化，併記錄入院時基本資料及3箇月死亡／主要殘疾及複髮等情況。結果2箇亞組中，榦預組和對照組死亡／殘疾比率差異均無統計學意義（P＞0.05），隻有在近期服用降壓藥物患者中，榦預組複髮率明顯低于對照組（P＜0.05），而在近期未服用降壓藥物患者中，2組複髮率無明顯差彆（P＞0.05）。分彆對兩亞組患者進行多因素Logistic迴歸分析顯示，在調整年齡、高血壓史、入院SBP、入院NIHSS評分、3箇月SBP及3箇月內服用降壓藥情況等因素後，急性期降壓治療均不影響急性腦梗死3箇月預後。結論腦梗死患者急性期給予適度降壓治療不能增加或降低3箇月死亡／緻殘和複髮的風險，所以血壓管理需依據病情實行箇體化原則。
목적：탐토뇌경사급성기강압치료여3개월예후적관계，위급성뇌경사환자혈압관리제공의거。방법장입선적452례급성뇌경사환자의거발병전2주내시부복용강압약물분위2개아조，장량아조수궤분위간예조화대조조。간예조급여강압치료[입원24 h내수축압（SBP）하강10％～20％，7～14 d혈압140／90 mmHg（1 mmHg＝0.133 kPa）이하]，대조조불강압。동태감측소유환자14 d내적혈압변화，병기록입원시기본자료급3개월사망／주요잔질급복발등정황。결과2개아조중，간예조화대조조사망／잔질비솔차이균무통계학의의（P＞0.05），지유재근기복용강압약물환자중，간예조복발솔명현저우대조조（P＜0.05），이재근기미복용강압약물환자중，2조복발솔무명현차별（P＞0.05）。분별대량아조환자진행다인소Logistic회귀분석현시，재조정년령、고혈압사、입원SBP、입원NIHSS평분、3개월SBP급3개월내복용강압약정황등인소후，급성기강압치료균불영향급성뇌경사3개월예후。결론뇌경사환자급성기급여괄도강압치료불능증가혹강저3개월사망／치잔화복발적풍험，소이혈압관리수의거병정실행개체화원칙。
Objective To explore the influnence of antihypertension on long‐term prognosis in patients with acute cerebral infarction and provide guidance for clinical treatment. Methods Totally 452 cases of patients with acute ischemic stroke were divided into two subgroup whether to take in antihypertensive agent within 2 weeks of symptom onset. The two subsets partici‐pants were randomly divided into blood pressure intervention group and control group. Antihypertensive therapy was given to the intervention group, with the target of lowering systolic blood pressure by 10% to 20% within the first 24 hours after ran‐domization, blood pressure<140/90 mmHg in the 7 to 14 days. However, the control group discontinued all antihypertensive medications. Blood pressures were monitored from day to 14 of admission. Baseline characteristics, the condition of death/ma‐jor disability and recurrent stroke of the two groups within 3 months were observed. Results Among participants in the two subgroup, antihypertensive agent have no diffence between treatment group and control group. Only in the subgroup who took in antihypertensive agent recently, does the treatment group have a lower recurrent stroke. However there are no deffence in the other subgroup. By using multiple logistic regression analysis adjusted for age, history of hypertension, NIHSS scores after admission and so on, antihypertensive therapy in acute phase does not influence 3 month prognosis of patients with cerebral in‐farction. Conclusion This trial indicates that antihypertensive treatment in patients with acute ischemic stroke does not decrease or increase the risk of adverse death/major disability and recurrent stroke. So clinical management of hypertension among acute ischemic stroke patients should be an individual decision based on comorbidities and cotreatments.
