CAJ | 학술논문

目的探讨升压治疗对收缩压（systolic blood pressure，SBP）在140～160 mmHg的急性脑分水岭梗死患者预后的影响。 　　方法本研究为前瞻性研究，连续选择2011年l月至2014年11月同济大学附属同济医院神经内科首次发病48 h内SBP在140～160 mmHg的急性脑分水岭梗死患者64例，分为升压治疗组29例和常规治疗组35例，升压治疗组除阿司匹林、阿托伐他汀等常规治疗外加用多巴胺升压治疗，使SBP较入院时血压上升约20 mmHg，维持3天。于入院时和2周采用美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale，NIHSS）评分、发病后6个月采用改良Rankin量表（modified Rankin Scale，mRS）评分对患者神经功能缺损评价，NIHSS减少46%以上视为升压治疗显效；mRS≤2分为预后良好。 　　结果两组患者入院时年龄、性别、发病时间和NIHSS评分等基线资料差异无显著性，入院2周时升压治疗组显效率为27.6%，与常规治疗组的28.6%比较差异无显著性（P=0.930）。发病6个月升压治疗组预后良好率为65.5%，高于常规治疗组的48.6%，但差异无显著性（P=0.174）。 　　结论升压治疗对SBP在140～160 mmHg的急性脑分水岭梗死患者无明显疗效。
목적탐토승압치료대수축압（systolic blood pressure，SBP）재140～160 mmHg적급성뇌분수령경사환자예후적영향。 　　방법본연구위전첨성연구，련속선택2011년l월지2014년11월동제대학부속동제의원신경내과수차발병48 h내SBP재140～160 mmHg적급성뇌분수령경사환자64례，분위승압치료조29례화상규치료조35례，승압치료조제아사필림、아탁벌타정등상규치료외가용다파알승압치료，사SBP교입원시혈압상승약20 mmHg，유지3천。우입원시화2주채용미국국립위생연구원졸중량표（National Institute of Health Stroke Scale，NIHSS）평분、발병후6개월채용개량Rankin량표（modified Rankin Scale，mRS）평분대환자신경공능결손평개，NIHSS감소46%이상시위승압치료현효；mRS≤2분위예후량호。 　　결과량조환자입원시년령、성별、발병시간화NIHSS평분등기선자료차이무현저성，입원2주시승압치료조현효솔위27.6%，여상규치료조적28.6%비교차이무현저성（P=0.930）。발병6개월승압치료조예후량호솔위65.5%，고우상규치료조적48.6%，단차이무현저성（P=0.174）。 　　결론승압치료대SBP재140～160 mmHg적급성뇌분수령경사환자무명현료효。
Objective To investigate the effect of elevated blood pressure(BP) on outcome of patients with acute cerebral watershed infarction(CWI) with systolic blood pressure(SBP) range from 140 to 160 mmHg. Methods Sixty-four successive patients with ifrst onset acute CWI with SBP range from 140 to 160 mmHg were enrolled in this prospective analysis, which was from department of neurology, Tongji hospital, Tongji University between January 2011 and November 2014. Patients were randomly divided into elevated BP treatment group(treatment group, 29 cases) and routine treatment group(routine group, 35 cases), Dopamine was given to elevate SBP about 20 mmHg in the treatment group besides routine ischemic stroke therapy including Aspirin and Atorvastatin etc. in the ifrst three days after admission. National Institutes of Health Stroke Scale(NIHSS) were recorded at admission and 2 weeks after admission or at discharge, modiifed Rankin Score(mRS) was collected for assessment of neurological function defect at 6 months after stroke. More than 46%decrease of NIHSS was deifned as effectivity of elevated BP treatment 2 weeks after admission or at discharge, and mRS≤2 was deifned as good outcome. Results There was no difference in baseline data including age, sex, disease time and NIHSS, etc. between two groups. The effective rate was 27.6%in treatment group and 28.6%in routine group 2 weeks after admission or at discharge. There was no statistic significance between two groups(P=0.930). The proportion of good outcome was higher in treatment group(65.5%) than in routine group(48.6%) at six months after stroke, but there was no statistic signiifcance(P=0.174). Conclusion Elevated BP treatment had no effect on obvious outcome in the patients with acute CWI with SBP ranged from 140 to 160 mmHg.