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1、缺血性卒中早期血压水平对大脑与肾脏血流灌注的影响孟品*,籍牛*,刘娜,张广慧,徐丙超,周芯羽,何明利(222000江苏连云港,徐州医学院附属连云港医院神经内科[摘要]目的:缺血性卒中早期血压管理方法尚不确定,本研究将探索缺血性卒中早期血压水平对大脑与肾脏血流灌注的影响和合理的血压管理方法。方法:入选发病24h内首发急性脑梗死患者873例,根据入院时血压水平分为静脉降压组、口服降压组和观察组,并将全组血压值分为7个水平统计。于发病3、6、12、24h动态监测血压,同步检测肾小球滤过率(GFR)、颈内动脉流量(ICAF),采用单因素
2、与多因素COX比例风险模型分析血压水平与判定为灌注良好、灌注不足和灌注衰退之灌注结果的概率。结果:入院时静脉降压组血压水平显著高于口服降压组(P<0.05)。两组给药时间相当情况下,静脉降压组血压水平降至(143.2±13.7)/(93.6±10.2)mmHg,显著低于口服降压组(153.7±12.8)/(106.3±11.6)mmHg(P<0.001)。在收缩压(SBP)140~159mmHg和舒张压(DBP)90~99mmHg组,灌注良好的概率最高且灌注不足与灌注衰退的风险最低;而在SBP≥180mmHg和DBP≥110mm
3、Hg以上组,灌注良好的概率较低且灌注不足与灌注衰退风险的较高,剔除潜在的混杂因素后这种关系依然存在。结论:脑梗死早期血压水平与脑肾血流灌注密切相关。对入院血压≥180/110mmHg的患者,于发病24h内给予静脉降压治疗,使其血压维持在140~159/90~99mmHg的“轻度高血压水平”,有利于脑肾血流灌注。[关键词]脑梗死;血压;器官血流灌注[基金项目]江苏省科技厅临床医学科技专项(BL2014062)和江苏省卫生厅科研基金(H2014061)和江苏省卫生厅科技项目(Y2013032)*同等贡献者[通信作者]何明利,E-ma
4、il:lyghml@163.comEffectofBloodPressureonthePerfusionofCerebralandRenalinpatientswithEarlyPhaseofIschemicStrokeMengPin,JiNiu,LiuNa,ZhangGuanghui,XuBingchao,ZhouXinyu,HeMingLi(DepartmentofNeurology,Lianyunganghospital,affiliatedXuzhoumedicalcollege)[Abstract]Objective:
5、Itisuncertainthatthebloodpressuremanagementinearlyphaseofischemicstroke.Ourstudyisaimtoexplorehowtheeffectofbloodpressureontheperfusionofcerebralandrenalaswellastheoptimizationmethodaboutthebloodpressuremanagementinearlyphaseofischemicstroke.MethodEighthundredseventy
6、-threepatientswithfirstonsetofcerebralinfarctionwithin24hourswereselected,andweredividedintointravenousantihypertensivegroup,oralantihypertensivegroupandobservationgroupbasedonadmissionbloodpressure.Thebloodpressurevaluesrangeisdividedintosevengroupsandstatistics.The
7、bloodpressureattheonsetof3h,6h,12h,24hweredynamicmonitored.Glomerularfiltrationrate(GFR),internalcarotidarteryflow(ICAF)weresynchronousdetected.Theassociateofbloodpressurelevelsandtheprobabilityofperfusionoutcomewhichwerejudgedasgoodperfusion,inadequateperfusionandpe
8、rfusionrecessionwereanalyzedusingunivariateandmultivariateCOXproportionalhazardanalysis.ResultsBloodpressureatadmissionwas(184.5±23