急性前循环大动脉闭塞性血管内治疗患者术中血压变异与远期预后相关性研究

阮婕; 殷聪国; 黄焕; 夏文卿; 李凌菲; 桑红菲; 陈子晞; 蒋琳

doi:10.16016/j.2097-0927.202111058

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急性前循环大动脉闭塞性血管内治疗患者术中血压变异与远期预后相关性研究

临床医学 | 更新时间：2026-01-09

- 急性前循环大动脉闭塞性血管内治疗患者术中血压变异与远期预后相关性研究
- Correlation of intraoperative blood pressure variability and long-term prognosis in patients with anterior circulation stroke undergoing endovascular therapy
- 陆军军医大学学报 2022年44卷第11期页码：1149-1155
- 作者机构：
  
  1.310003 杭州，浙江大学医学院附属第一医院临床药学研究中心
  2.310006 杭州，浙江大学医学院附属杭州市第一人民医院：神经内科
  3.400037 重庆，陆军军医大学(第三军医大学)第二附属医院神经内科
  4.310006 杭州，浙江大学医学院附属杭州市第一人民医院：急诊科
- 作者简介：
  
  [蒋琳，E-mail：jianglin0229@126.com JIANG Lin: E-mail: jianglin0229@126.com
- 基金信息：
  
  国家自然科学基金青年科学基金(81801157);浙江省基础公益研究计划项目(LGF20H090008);杭州市科技计划引导项目(农业与社会发展)(20163501Y03)
- DOI：10.16016/j.2097-0927.202111058
  中图分类号： R443.5;R741.05;R743.33
- 收稿：2021-11-08，
  
  修回：2021-12-15，
  
  纸质出版：2022-06-15
- 稿件说明：
移动端阅览
阮婕, 殷聪国, 黄焕, 等. 急性前循环大动脉闭塞性血管内治疗患者术中血压变异与远期预后相关性研究[J]. 陆军军医大学学报, 2022,44(11):1149-1155.

Jie RUAN, Congguo YIN, Huan HUANG, et al. Correlation of intraoperative blood pressure variability and long-term prognosis in patients with anterior circulation stroke undergoing endovascular therapy[J]. Journal of Army Medical University, 2022, 44(11): 1149-1155.
阮婕, 殷聪国, 黄焕, 等. 急性前循环大动脉闭塞性血管内治疗患者术中血压变异与远期预后相关性研究[J]. 陆军军医大学学报, 2022,44(11):1149-1155. DOI： 10.16016/j.2097-0927.202111058.

Jie RUAN, Congguo YIN, Huan HUANG, et al. Correlation of intraoperative blood pressure variability and long-term prognosis in patients with anterior circulation stroke undergoing endovascular therapy[J]. Journal of Army Medical University, 2022, 44(11): 1149-1155. DOI： 10.16016/j.2097-0927.202111058.

摘要

目的

探究急性前循环大动脉闭塞性血管内治疗患者术中血压变异对患者卒中后3个月神经功能预后及术后颅内出血转化的影响。

方法

回顾性分析2015年10月到2018年8月在浙江大学医学院附属杭州市第一人民医院神经内科收治的116例急性前循环大动脉闭塞血管内治疗患者，记录并分析患者术中血压。血压变异参数包括：分别计算收缩压及舒张压的最大值、最小值、平均值、极差、标准差、变异系数。患者发病90 d改良Rankin评分评价患者远期预后，0~2分提示预后良好。次要预后评价指标为血管内治疗术后1周内出血转化，包括出血性脑梗死、脑实质出血和症状性颅内出血。

结果

在116例患者中，72例(62.1%)患者获得良好预后。44例患者(37.9%)术后1周内发生梗死后出血转化，其中27例患者表现为出血性脑梗死，17例表现为脑实质出血，9例(7.8%)患者术后发生症状性颅内出血。多因素回归分析结果显示：术中收缩压极差(

: 0.976

95%

: 0.943~0.992

=0.010)、收缩压变异系数(

: 0.903

95%

: 0.823~0.992

=0.033)、舒张压极差(

: 0.937

95%

: 0.894~0.985

=0.01)、舒张压变异系数(

: 0.873

95%

: 0.785~0.970

=0.012)与远期不良预后呈正相关；术中收缩压最大值(

: 1.037

95%

: 1.005~1.070

=0.024)、收缩压平均值(

: 1.051

95%

: 1.013~1.091

=0.009)、舒张压最大值(

: 1.088

95%

: 1.031~1.148

=0.002)、舒张压平均值(

: 1.116

95%

: 1.041~1.196

=0.002)与出血性梗死发生呈正相关。

结论

急性前循环大动脉闭塞性脑梗死患者中，血管内治疗术中血压变异越大，远期预后越差，术后出血性脑梗死发生率越高。血管内治疗术中血压管理尤为重要。

Abstract

Objective

To investigate the effects of blood pressure variability (BPV) during thrombectomy on functional outcomes and hemorrhagic transformation for anterior circulation stroke.

Methods

We enrolled 116 patients with acute ischemic stroke due to large-vessel occlusion who received endovascular therapy in Department of Neurology of Hangzhou First People′s Hospital from October 2015 to August 2018 and analyzed their blood pressure (BP) records during thrombectomy. We calculated BPV: maximum (max)

minimum (min)

mean

range

standard deviation (SD)

coefficient variation (CV) of systolic (SBP) and diastolic BP (DBP). Functional outcomes were evaluated using modified Rankin Scale (mRS) score in 90 d after surgery. Other outcomes were hemorrhagic infarction (HI)

parenchymal hemorrhage (PH) and symptomatic intracerebral hemorrhage (sICH).

Results

Among the total 116 enrolled patients

72 patients (62.1%) achieved good outcome. Forty-four patients (37.9%) developed hemorrhagic transformation (HT)

among whom 27 were identified with HI and 17 with PH. Nine patients (7.8%) deteriorated to sICH. Multivariate regression analysis showed that larger intraoperative SBP range (

=0.976

95%

: 0.943~0.992

=0.010) and higher SBP CV (

=0.903

95%

: 0.823~0.992

=0.033)

and DBP range (

=0.937

95%

: 0.894~0.985

=0.01) and DBP CV (

=0.873

95%

: 0.785~0.970

=0.012) were positively correlated with long-term adverse prognosis. While higher intraoperative maximum SBP (

=1.037

95%

: 1.005~1.070

=0.024) and DBP (

=1.088

95%

: 1.031~1.148

=0.002) and mean SBP (

=1.051

95%

: 1.013~1.091

=0.009) and mean DBP (

=1.116

95%

: 1.041~1.196

=0.002) had positive correlation with HI.

Conclusion

For the patients with acute ischemic stroke due to large-vessel occlusion

the greater the blood pressure variation during endovascular therapy

the worse the long-term prognosis

and the higher the incidence of postoperative HI. It is essential for intraoperative BP control during thrombectomy.

关键词

Keywords

references

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