摘要
目的探讨大血管闭塞(large-vessel occlusion,LVO)患者血管内血栓切除术(endovascular thrombectomy,ET)术后24 h血压变异性与早期神经功能改善(early neurological improvement,ENI)的相关性。方法回顾性纳入2012年1月至2018年2月期间在南通大学附属医院急诊接受ET治疗的LVO患者。在ET术后最初24 h内每2 h记录一次血压,通过标准差(standard deviation,SD)和连续变异度(successive variation,SV)评估血压变异性。在ET术后24 h复评美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分,复评0分或较基线评分降低≥4分定义为ENI。应用多变量logistic回归分析评估血压变异性与ENI的联系。结果共纳入接受ET治疗的LVO患者74例,其中39例(52.7%)出现ENI。单变量分析显示,ENI组术后血管再通良好的患者比例显著高于非ENI组(P<0.05),而基线总胆固醇以及ET术后24 h平均收缩压、平均舒张压、收缩压变异性(systolic blood pressure variability,SBPV)-SD和SBPV-SV均显著低于非ENI组(P均<0.05)。多变量logistic回归分析显示,SBPV-SV较高是非ENI的独立危险因素(优势比1.223,95%置信区间1.038~1.440;P=0.016)。结论ET术后SBPV-SV较高与LVO患者早期神经功能改善不良相关,有望作为ET术后患者血压管理的潜在目标。
Objective To investigate the correlation between 24 h blood pressure variability and early neurological improvement(ENI)in patients with large vessel occlusion(LVO)after endovascular thrombectomy(ET).Methods Patients with LVO received ET in the Emergency Department,the Affiliated Hospital of Nantong University from January 2012 to February 2018 were enrolled retrospectively.During the first 24 h after ET,the blood pressure was recorded every 2 h,and blood pressure variability was evaluated by standard deviation(SD)and successive variation(SV).At 24 h after ET,the National Institutes of Health Stroke Scale(NIHSS)score was evaluated again.The re-evaluation of 0 point or a decrease of≥4 from the baseline score was defined as ENI.Multivariate logistic regression analysis was used to evaluate the relationship between blood pressure variability and ENI.Results A total of 74 patients with LVO received ET were enrolled,of which 39(52.7%)had ENI.Univariate analysis showed that the proportion of patients with good recanalization in the ENI group after procedure were significantly higher than that in the non-ENI group(P<0.05),while the average systolic blood pressure,average diastolic blood pressure,systolic blood pressure variability(SBPV)-SD and SBPV-SV within 24 h after ET and baseline total cholesterol level were significantly lower than those in the non-ENI group(all P<0.05).Multivariate logistic regression analysis showed that higher SBPV-SV was an independent risk factor for non-ENI(odds ratio 1.223,95%confidence interval 1.038-1.440;P=0.016).Conclusion Higher SBPV-SV after ET is associated with poor early neurological improvement in patients with LVO,and it is expected to be a potential target for blood pressure management in patients after ET.
作者
瞿启飞
周红
周宏智
吴新民
徐添
柯开富
Qu Qifei;Zhou Hong;Zhou Hongzhi;Wu Xinmin;Xu Tian;Ke Kaifu(Department of Neurology,Tongzhou District People's Hospital,Nantong 226399,China;Department of Neurology,the Affiliated Hospital of Nantong University,Nantong 226001,China)
出处
《国际脑血管病杂志》
2021年第7期485-490,共6页
International Journal of Cerebrovascular Diseases
基金
国家自然科学基金项目(81873742,82073627)
中国博士后科学基金(2020M671564)
江苏省博士后科学基金(2020Z039)
江苏省科教强卫工程青年医学重点人才项目(QNRC2016694)
南通市科技计划项目社会民生科技面上项目(MS12019014)
南通市第五期226高层次人才培养工程。
关键词
卒中
脑缺血
血压
血管内手术
血栓切除术
治疗结果
时间因素
危险因素
Stroke
Brain ischemia
Blood pressure
Endovascular procedures
Thrombectomy
Treatment outcome
Time factors
Risk factors
