血栓切除术后严格控制血压与神经元损伤和功能不良结果有关
Marianne Hahn1, Eyad Hayani1, Lynn Bitar1
1Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Annals of clinical and translational neurology
|September 25, 2023
概括
在中风机械血栓切除术后,严格控制血压可能会增加神经元损伤并恶化结果. 较低的血压目标与较高的神经纤维光链水平和较差的功能恢复有关.
科学领域:
- 神经学 神经学
- 心血管医学 心血管医学
- 生物标志物 生物标志物
背景情况:
- 机械血栓切除术 (MT) 是急性缺血性中风与大血管封闭 (LVO) 的标准治疗方法.
- 在MT后的最佳血压 (BP) 管理仍然不清楚,这会影响患者的康复.
- 了解BP目标和神经结果之间的关系对于中风后的护理至关重要.
研究的目的:
- 研究严格达到≤160/90mmHg的血压目标与神经元损失之间的关联.
- 评估严格的BP控制对LVO的MT后的功能结果的影响.
- 探索BP参数,神经纤维光链 (sNfL) 水平和MT后恢复之间的相关性.
主要方法:
- 在古登堡中风研究中,为LVO接受MT的患者的未来招生.
- 在MT后24小时内每半小时测量血压,将患者分为"低血压" (≤160/90 mmHg) 或"高血压" (>160/90 mmHg) 组.
- 使用血清神经丝光链 (sNfL) 水平在三天内量化神经元损失;进行了相关性和回归分析.
主要成果:
- "低血压"组 (21.2%的患者) 显示不良的90天功能结果 (aOR:5.88) 和生活质量下降.
- 在"低血压"组中观察到高的sNfL水平,表明神经元损伤增加 (p=0.026).
- 在"低血压"组中,低血压发作更频繁 (48.6%),sNfL水平有效地识别这些情况 (AUC:0.68).
结论:
- 对于LVO,在24小时内严格控制血压 (≤160/90 mmHg),与神经元损伤的增加有关.
- 较低的血压目标与较高的sNfL水平和较差的功能结果相关,这表明潜在的低血压诱导的损害.
- 调查结果表明,过于严格的BP管理可能会在MT后的早期阶段有害.
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