急性前循环缺血性脑卒中患者机械取栓术后超早期强化降压的有效性与安全性
Efficacy and Safety of Ultra-early Intensive Hypotension after Mechanical Thrombectomy in Patients with Acute Anterior Circulation Ischemic Stroke
马丽娟 1吴垠 1李光宗1
作者信息
- 1. 610000 成都,成都市第六人民医院神经内科
- 折叠
摘要
目的 探讨超早期强化降压在急性前循环缺血性脑卒中患者机械取栓术后的应用及其有效性与安全性.方法 选取2020 年1 月—2022 年10 月接受机械取栓术治疗的102 例急性前循环缺血性脑卒中为研究对象,采用奇偶数分组法分为观察组和对照组,每组51 例.对照组术后采取常规降压,观察组术后采取超早期强化降压.比较2 组临床疗效、手术前后血压控制情况、血清指标[氧磷酶-1(PON-1)、脂蛋白相关磷脂酶A2(Lp-PLA2)、神经元特异性烯醇化酶(NSE)]、脑水肿加重程度、美国国立卫生研究院卒中量表(NIHSS)评分及预后相关情况.结果 观察组总有效率94.12%(48/51)与对照组90.20%(46/51)比较差异无统计学意义(P＞0.05).术后 24、48 h,观察组收缩压、平均动脉压以及脑水肿加重程度低于对照组(P＜0.05).术后 24 h,2 组血清PON-1 水平高于术前,Lp-PLA2、NSE水平低于术前(P＜0.05),但2 组间比较差异无统计学意义(P＞0.05).术后24h、48h、90 d,2 组NIHSS评分低于术前(P＜0.05),但2 组间比较差异无统计学意义(P＞0.05).2 组症状性颅脑出血发生率、脑血管再闭塞发生率、术后90d预后良好率及术后90d死亡率比较差异无统计学意义(P＞0.05).结论 急性前循环缺血性脑卒中患者机械取栓术后超早期强化降压可在短时间内有效控制血压,减轻脑水肿,改善患者神经功能,且具有一定安全性.
Abstract
Objective To investigate the efficacy and safety of ultra-early intensive hypotension after mechanical thrombectomy in patients with acute anterior circulation ischemic stroke(AACIS).Methods A total of 102 patients with AACIS who received mechanical thrombus removal from January 2020 to October 2022 were selected as the research subjects,and were divided into observation group and control group by odd-even grouping method,with 51 cases in each group.The control group received routine hypotension after operation,and the observation group received ultra-early intensive hypotension after operation.The clinical efficacy,blood pressure control before and after operation,serum indexes[paraoxonase-1(PON-1),lipoprotein-associated phosphesterase A2(Lp-PLA2),neuron-specific enolase(NSE)],severity of cerebral ede-ma,National Institutes of Health Stroke Scale(NIHSS)score and prognostic factors between the two groups were compared.Results The total effective rate was94.12%(48/51)in the observation group and90.20%(46/51)in the control group,suggesting no significant difference(P＞0.05).At 24 and 48 h after operation,systolic blood pressure,mean arterial pres-sure and the severity of cerebral edema in the observation group were lower than those in the control group(P＜0.05).At 24 h after operation,the serum PON-1 level in the two groups was higher than that before operation,while the levels of Lp-PLA2 and NSE were lower than those before operation(P＜0.05),but there was no statistical significance between the two groups(P＞0.05).At 24 h,48 h and90 d after operation,NIHSS score in the two groups was lower than that before op-eration(P＜0.05),but there was no statistical significance between the two groups(P＞0.05).There was no significant difference in the incidence of symptomatic craniocerebral hemorrhage,cerebrovascular re-occlusion,excellent and good rate of prognosis and mortality at 90 days after surgery between the two groups(P＞0.05).Conclusion Ultra-early intensive hypo-tension after mechanical thrombectomy in patients with AACIS can effectively control blood pressure in a short period of time,alleviate cerebral edema,improve the neurological function of patients,and have a certain safety.
关键词
急性前循环缺血性脑卒中/机械取栓术/强化降压/超早期/脑水肿/血压/神经功能/预后Key words
Acute anterior circulation ischemic stroke/Mechanical thrombectomy/Intensive hypotension/Ultra-early stage/Brain edema/Blood pressure/Neural function/Prognosis引用本文复制引用
基金项目
四川大学华西医院学科卓越发展1·3·5 工程项目脑血管病研究及其高端人才培养项目(ZYGD18009)
出版年
2023
国家科技期刊平台
NSTL
万方数据