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在急性缺血性中风 (ENCHANTED2/MT) 中进行血管内血栓切除后的密集血压控制:多中心,开放,盲目的,随机对照试验

Pengfei Yang¹, Lili Song², Yongwei Zhang¹

¹Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China; Changhai Clinical Research Unit, Changhai Hospital, Naval Medical University, Shanghai, China.

Lancet (London, England)

|November 7, 2022

概括

在中风治疗后强烈降低血压可能会对患者造成伤害. 一项试验发现,缩血压低于120毫米升的患者在血管内血栓切除术后出现不良结果和残疾.

科学领域:

神经学
心脏病学
危急护理医学

背景情况:

对于急性缺血性中风的内血管血栓切除术后的最佳静脉血压目标仍然不清楚.
重灌后血压升高很常见,因此需要研究血压管理策略.

研究的目的:

为了比较强度和低强度的降血压治疗的安全性和有效性.
确定不同静脉压目标对内血管血栓切除术患者的功能恢复和安全结果的影响.

主要方法:

一个开放的,盲目的,随机的受控试验,涉及中国44家医院的821名患者.
血栓切除术后血压升高 (≥140 mm Hg) 的患者被随机分配到120 mm Hg (强度) 或140 - 180 mm Hg (不那么强度) 的血压目标体内72小时.
主要结局是通过修改的兰金尺度评估90天后的功能恢复;安全结局包括早期的神经恶化和症状性脑内出血.

主要成果:

由于对疗效和安全性的担忧,该试验被提前停止. 与较少强化治疗组相比,强化治疗组的功能表现较差的可能性更高 (OR 1. 37).
密集治疗组的患者在90天后出现了较早的神经恶化 (OR1. 53) 和严重残疾 (OR2. 07).
在症状性脑内出血,严重不良事件或死亡率方面没有观察到显著差异.

结论:

在急性缺血性中风中进行血管内血栓切除后,应避免密集控制系统血压 (< 120 mm Hg).
较少的血压管理 (140 - 180毫米升) 似乎更安全,并可能改善该患者群体的功能恢复.

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