切换至 "中华医学电子期刊资源库"

中华脑血管病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 53 -56. doi: 10.11817/j.issn.1673-9248.2022.01.011

综述

急性缺血性卒中血压管理的研究现状及进展
魏宸铭1, 宋晓微1, 桑振华1, 武剑1,()   
  1. 1. 102218 北京清华长庚医院神经内科
  • 收稿日期:2021-04-16 出版日期:2022-02-01
  • 通信作者: 武剑
  • 基金资助:
    首都卫生发展科研专项资助(2020-1-2241); 北京市医管中心临床医学发展专项经费资助,扬帆计划交叉学科培育项目(XMLX202140)

Blood pressure management in acute ischemic stroke: the state-of-the-art and the prospects

Chenming Wei1, Xiaowei Song1, Zhenhua Sang1, Jian Wu1,()   

  1. 1. Neurology department, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
  • Received:2021-04-16 Published:2022-02-01
  • Corresponding author: Jian Wu
引用本文:

魏宸铭, 宋晓微, 桑振华, 武剑. 急性缺血性卒中血压管理的研究现状及进展[J/OL]. 中华脑血管病杂志(电子版), 2022, 16(01): 53-56.

Chenming Wei, Xiaowei Song, Zhenhua Sang, Jian Wu. Blood pressure management in acute ischemic stroke: the state-of-the-art and the prospects[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2022, 16(01): 53-56.

缺血性卒中急性期血压管理是影响临床预后的重要干预措施之一。多种因素可导致缺血性卒中患者急性期血压升高,该现象较为常见,少数可出现低血压现象。卒中急性期血压水平与临床预后相关,过高或过低血压均与不良预后相关,但急性期血压具体管理策略目前尚无定论。血管再通治疗的患者急性期血压升高与症状性颅内出血风险增加相关,血压管理需更为严格,但是否需要进一步积极降压需结合患者具体情况分析。

Blood pressure (BP) management in acute ischemic stroke is one of the important intervention affecting clinical prognosis. Many factors in patients with ischemic stroke can lead to increased BP in the acute stage, which is relatively common, while few patients may manifest hypotension. BP is a key factor affecting the clinical outcomes according to the previous studies. Too high or too low BP is related to the poor prognosis, but the specific management strategy of BP in the acute stage has not been determined yet. Increased BP during the acute phase of recanalization treatment is associated with an increased risk of symptomatic intracranial hemorrhage. The management of BP needs to be more rigorous, but the need for intensive BP control should be analyzed in light of the individual patient's features.

1
Wu S, Wu B, Liu M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management [J]. Lancet Neurol, 2019, 18(4): 394-405.
2
Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults [J]. Circulation, 2017, 135(8): 759-771.
3
中国卒中防治报告编写组. 《中国脑卒中防治报告2019》概要 [J]. 中国脑血管病杂志, 2020, 17(5): 272-281.
4
Gąsecki D, Kwarciany M, Kowalczyk K, et al. Blood pressure management in acute ischemic stroke [J]. Curr Hypertens Repo, 2021, 23(1): 3.
5
Qureshi AI, Ezzeddine MA, Nasar A, et al. Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States [J]. Am J Emerg Med, 2007, 25(1): 32-38.
6
Ahmed N, Wahlgren N, Brainin M, et al. Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis: retrospective analysis from Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) [J]. Stroke, 2009, 40(7): 2442-2449.
7
Fischer U, Cooney MT, Bull LM, et al. Acute post-stroke blood pressure relative to premorbid levels in intracerebral haemorrhage versus major ischaemic stroke: a population-based study [J]. Lancet Neurol, 2014, 13(4): 374-384.
8
Britton M, Carlsson A, de Faire U. Blood pressure course in patients with acute stroke and matched controls [J]. Stroke, 1986, 17(5): 861-864.
9
Jiang B, Churilov L, Kanesan L, et al. Blood pressure may be associated with arterial collateralization in anterior circulation ischemic stroke before acute reperfusion therapy [J]. J Stroke, 2017, 19(2): 222-228.
10
Christoforidis GA, Saadat N, Kontzialis M, et al. Predictors for the extent of pial collateral recruitment in acute ischemic stroke [J]. Neuroradiol, 2020, 33(2): 98-104.
11
Toyoda K, Okada Y, Jinnouchi J, et al. High blood pressure in acute ischemic stroke and underlying disorders [J]. Cerebrovasc Dis, 2006, 22(5-6): 355-361.
12
Wohlfahrt P, Krajcoviechova A, Jozifova M, et al. Low blood pressure during the acute period of ischemic stroke is associated with decreased survival [J]. J Hypertens, 2015, 33(2): 339-345.
13
Fischer U, Mattle HP. Blood pressure in acute stroke: still no answer for management [J]. Stroke, 2017, 48(7): 1717-1719.
14
Koton S, Eizenberg Y, Tanne D, et al. Trends in admission blood pressure and stroke outcome in patients with acute stroke and transient ischemic attack in a National Acute Stroke Registry [J]. J Hypertens, 2016, 34(2): 316-322.
15
Sripal B, Lee S, Eric E S, et al. Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke [J]. Eur Heart J, 2017, 38(37): 2827-2835.
16
Robinson TG, Potter JF, Ford GA, et al. Effects of antihypertensive treatment after acute stroke in the Continue or Stop Post-Stroke Antihypertensives Collaborative Study (COSSACS): a prospective, randomised, open, blinded-endpoint trial [J]. Lancet Neurol, 2010, 9(8): 767-775.
17
Ishitsuka K, Kamouchi M, Hata J, et al. High blood pressure after acute ischemic stroke is associated with poor clinical outcomes. Fukuoka Stroke Registry [J]. Hypertension. 2014, 63(1): 54-60.
18
Eivind B, Geoffrey C, Richard I, et al. Effects of blood pressure and blood pressure-lowering treatment during the first 24 hours among patients in the third international stroke trial of thrombolytic treatment for acute ischemic stroke [J]. Stroke, 2015, 46(12): 3362-33629.
19
Potter JF, Robinson TG, Ford GA, et al. Controlling hypertension and hypotension immediately post-stroke (CHHIPS): a randomised, placebo-controlled, double-blind pilot trial [J]. Lancet Neurol, 2009, 8(1): 48-56.
20
He J, Zhang Y, Xu T, et al. Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized clinical trial [J]. JAMA, 2014, 311(5): 479-489.
21
The ENOS Trial Investigators. Efficacy of nitric oxide, with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS): a partial-factorial randomised controlled trial [J]. Lancet, 2015, 385(9968): 617-628.
22
Sandset EC, Bath PM, Boysen G, et al. The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, placebo-controlled, double-blind trial [J]. Lancet, 2011, 377(9767): 741-750.
23
Hornslien AG, Sandset EC, Igland J, et al. Effects of candesartan in acute stroke on vascular events during long-term follow-up: results from the Scandinavian Candesartan Acute Stroke Trial (SCAST) [J]. Int J Stroke, 2015, 10(6): 830-835.
24
Wang H, Tang Y, Rong X, et al. Effects of early blood pressure lowering on early and long-term outcomes after acute stroke: an updated meta-analysis [J]. PLoS One, 2014, 9(5): e97917.
25
Lee M, Ovbiagele B, Hong KS, et al. Effect of blood pressure lowering in early ischemic stroke: meta-analysis [J]. Stroke, 2015, 46(7):1883-1889.
26
Maya M, Egido JA, Ford GA, et al. Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase: safe implementation of treatments in stroke (SITS) symptomatic intracerebral hemorrhage risk score [J]. Stroke, 2012, 43(6): 1524-1531.
27
中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018 [J]. 中华神经科杂志, 2018, 51(9): 666-682.
28
William P, Alejandro R, Teri A, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Associatio [J]. Stroke, 2019, 50(12): e344-e418.
29
National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke [J]. N Engl J Med, 1995, 33(24): 1581-1587.
30
Anderson CS, Huang Y, Lindley RI, et al. Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial [J]. Lancet, 2019, 393(10174): 877-888.
31
Malhotra K, Ahmed N, Filippatou A, et al. Association of elevated blood pressure levels with outcomes in acute ischemic stroke patients treated with intravenous thrombolysis: a systematic review and meta-analysis [J]. J Stroke, 2019, 21(1): 78-90.
32
中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组, 中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性脑卒中早期血管内介入诊疗指南2018 [J]. 中华神经科杂志, 2018, 51(9): 683-691.
33
Maïer B, Delvoye F, Labreuche J, et al. Impact of blood pressure after successful endovascular therapy for anterior acute ischemic stroke: a systematic review [J]. Front Neurol, 2020, 11: 573382.
34
Marius M, Charith C, Matteo B, et al. Blood pressure after endovascular thrombectomy: modeling for outcomes based on recanalization status [J]. Stroke, 2020, 51(2): 519-525.
35
Mulder MJHL, Ergezen S, Lingsma HF, et al. Baseline blood pressure effect on the benefit and safety of intra-arterial treatment in MR CLEAN (multicenter randomized clinical trial of endovascular treatment of acute ischemic stroke in the Netherlands) [J]. Stroke, 2017, 48(7): 1869-1876.
36
Mikael M, Sebastien R, Bertrand L, et al. Safety and efficacy of intensive blood pressure lowering after successful endovascular therapy in acute ischaemic stroke (BP-TARGET): a multicentre, open-label, randomised controlled trial [J]. Lancet Neurol, 2021, 20(4): 265-274.
37
Hong L, Cheng X, Lin L, et al. The blood pressure paradox in acute ischemic stroke [J]. Ann Neurol, 2019, 85(3): 331-339.
[1] 周易, 张红梅, 尹立雪, 杨浩, 付培. 四川省超声医学质量控制指标动态变化趋势分析[J/OL]. 中华医学超声杂志(电子版), 2024, 21(07): 664-670.
[2] 王晓娜, 张宁, 宋伟, 杨明, 李丽, 薛红元. 河北省超声医学质量管理与控制现状分析[J/OL]. 中华医学超声杂志(电子版), 2024, 21(07): 675-680.
[3] 陈雪琪, 张莉, 郭乡平, 罗林枝, 晋思琦, 陈程, 赵瑞娜, 施敏, 杨筱, 李建初. 基于可验证自学学分管理系统比较超声医师继续教育中手机APP端与PC端需求[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 527-533.
[4] 李楠, 邱思齐, 薛鸣宇, 张英. 自伤性口腔损害及其疾病管理[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(05): 307-311.
[5] 姜然, 张海泳. 腹腔镜食管裂孔疝修补术患者围手术期手术配合的精细化管理与应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 584-587.
[6] 江西省神经外科质量控制中心. 江西省心源性脑卒中多学科协作防治专家共识[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 264-277.
[7] 张洪, 杨琪, 罗静, 唐茜, 邓鸿, 巩文艳, 王丽坤, 刘静, 艾双春. 多靶点神经调控技术对卒中后上肢运动功能障碍患者的脑网络功能连接研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 278-284.
[8] 许方军, 曹晓光, 王修敏, 王婷, 陈冬冬, 余程冬, 张鹤言. 基于闭环理论的动作观察疗法联合躯干控制训练对脑卒中后下肢运动的影响[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 292-299.
[9] 张雅文, 尹昱, 陈江龙, 杨玉慧, 吕红香, 张琦, 吕佩源. Theta爆发式经颅磁刺激治疗失语症的研究进展[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 306-311.
[10] 陈秀梅, 陈思涓, 郑小静. 护理联盟体构建及实践的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 703-708.
[11] 李茂军, 唐彬秩, 吴青, 阳倩, 梁小明, 邹福兰, 黄蓉, 陈昌辉. 新生儿呼吸窘迫综合征的管理:多国指南/共识及RDS-NExT workshop 共识陈述简介和评价[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 607-617.
[12] 张平骥, 徐钰, 李天水, 庞文翼, 符师宁, 张梦圆. 重症患者镇静治疗现状及期望的调查研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 562-567.
[13] 胡云鹤, 周玉焯, 付瑞瑛, 于凡, 李爱东. CHS-DRG付费制度下GB1分组住院费用影响因素分析与管理策略探讨[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 568-574.
[14] 耿晓坤. 缺血性卒中后无效再灌注的时间窗、组织窗与神经保护[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(06): 636-636.
[15] 李璇, 邓岚, 郭微, 邓永梅, 刘杰昕. 标准化皮肤管理流程在防治脑卒中患者失禁相关性皮炎中的应用[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 479-482.
阅读次数
全文


摘要