【作者】 聂志余； 陈玉辉； 李艳成； 封亮； 靳令经；

【Author】 NIE Zhiyu;CHEN Yuhui;LI Yancheng;FENG Liang;JIN Lingjing;Department of Neurology, Tongji Hospital, Tongji University;

【机构】 同济大学附属同济医院神经内科；

【摘要】 目的。探讨升压治疗对急性脑分水岭梗死患者近期及远期预后的影响。方法。选择首次发病的急性脑分水岭梗死患者47例,入院时收缩压(SBP)在120-140mmHg范围,随机分为升压治疗组和常规治疗组,升压治疗组除常规治疗外给多巴胺升压治疗,使收缩压较入院时血压上升20mmHg左右,维持3天。分别于入院时和2周采用NIHSS评分,入院2周、发病后6个月采用改良Rankin量表(mRS)、Bathel指数(BI)对患者神经功能缺损评分。结果。入院2周时升压治疗组基本痊愈2例,显著进步6例,进步5例,无效5例,加重2例,有效率为40.0%。常规治疗组基本痊愈1例,显著进步3例,进步11例,无效9例,加重3例,有效率为14.8%。升压治疗组的有效率显著高于常规治疗组(p<0.05)。发病后6个月,升压治疗组和常规治疗组的mRS分别为1.5±1.2和2.2±1.6,两组间无统计学差异。但升压治疗组预后良好(mRS≤2分)的比例为78.9%,较常规治疗组的56.0%为高,两组间虽无统计学差异,但升压治疗有改善预后的趋势。结论。脑分水岭梗死急性期升压治疗可改善近期预后,但不能改善长期预后。更多还原

【Abstract】 Objective. To investigate the effect of elevated blood pressure(BP) on short-term outcome as well as long-term outcome of acute watershed infarction. Method. 47 patients with first onset acute cerebral watershed infarction(CWI) from January 2009 to June 2013 were enrolled in this prospective analysis. The diagnosis of acute CWI was confirmed by DWI and SBP at admission range from 120mmHg to 140mmHg. 47 patients were randomly divided into elevated BP treatment group(treatment group, 20 cases) and routine treatment group(routine group, 27 cases), Dopamine was given to elevate BP about 20mmHg in the treatment group besides routine ischemic stroke therapy in the first three days after admission. Scores of Barthel index(BI), modified Rankin Score(mRS) and the National Institutes of Health Stroke Scale(NIHSS) were recorded at admission, discharge as well as 6 months after discharge. The short-term outcome were graded as basic recovery(91%-100%), most improved(46%-90%), improved(16%-45%), invalid(0-15%) and Clinical exacerbation(0-15%) based on NIHSS subtraction at discharge. The basic recovery and most improved was defined as effectivity, and score of mRS≤2 or BI>75 defined as good long-term outcome. Result.47 patients was enrolled and 44 followed-up. The short-term outcome were basic recovery in 2 patients, most improved in 6, improved in 5, invalid in 5 and Clinical exacerbation in 2 cases in the treatment group, compared with 1,3,11,9 and 3 patients respectively in routine group. The effective rate was higher(40.0%) in treatment group than routine group(14.8%). The score of mRS at 6 months after discharge were 1.5±1.2 in treatment group compared with 2.2±1.6 in routine group, there was no statistical significance(p>0.05). Nevertheless, the tendency of good long-term outcome was most significant, the proportion of mRS≤2 was higher(78.9%) in treatment group than 56.0% in routine group, although there was no statistical significance. There was no consciousness deterioration, hemorrhagic transformation and brain edema in the duration of elevated BP therapy. Conclusion. The elevated BP treatment can improve the short-term outcome, but could not improve the long-term outcome in the patients with acute CWI with DBP ranged from 120 to 140 mmHg.更多还原