在超急性中风中,救护车提供的强化血压降低
Gang Li1, Yapeng Lin1, Jie Yang1
1From the Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University (G.L., C.C., F.L., D.H., Y.Z., L.Z., G.M., Y.Y., J.H., Xiahong Xu, X. Xiong, Y.T.), the Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University (C.S.A., L. Song), Shanghai Pudong New District Medical Emergency Center (C.Z.), the Department of Neurology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine (F.W.), the Department of Neurology, Shanghai Pudong New District People's Hospital (X.Z.), the Department of Neurology, Gongli Hospital, Pudong New Area (M.J.), and the Department of Neurology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital (Xiaoyun Xu), Shanghai, the First Affiliated Hospital of Chengdu Medical College (Y.L., Y.G., J. Yu, S.L., S.H., F.M., Q.T.), the International Clinical Research Center, Chengdu Medical College (Y.L.), the Department of Neurology (J. Yang, S.T., N.Y., B.L., J.G.), the Institute of Neurology (J. Yang), Sichuan Provincial Key Laboratory for Human Disease Gene Study (J. Yang, S.T.), and the Departments of Neurosurgery (R.X.) and Emergency Medicine (M.S.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, and the First People's Hospital of Shuangliu District, Chengdu/West China (Airport) Hospital Sichuan University (Y.H.), Chengdu, the George Institute for Global Health China, Beijing (C.S.A., C.C., X.R., M.O., L. Song), Zigong Fourth People's Hospital, Zigong (P.X.), Fushun County People's Hospital, Fushun (L.W.), Kaijiang County People's Hospital, Kaijiang (D.Q.), QianWei County People's Hospital, Leshan (Y.P.), Dazhu People's Hospital, Dazhu (C.L.), the Department of Neurology, Yucheng People's Hospital, Yucheng (J.L.), the Department of Neurology, Sixian People's Hospital, Suzhou (Y.W.), Guanghan People's Hospital, Guanghan (X.W.), and the Department of Neurology, Xuzhou Central Hospital, Xuzhou (G.C.) - all in China; the George Institute for Global Health, Faculty of Medicine, University of New South Wales (C.S.A., C.C., L.B., Q.L., X.C., X.L., X.R., L.L., H.L., M.O., L. Song), the Neurology Department, Royal Prince Alfred Hospital (C.S.A.), Menzies Centre for Health Policy and Economics, University of Sydney (H.L.), Sydney Institute for Women, Children and Their Families, Sydney Local Health District (H.L.), and the School of Health Sciences, Western Sydney University (L. Si) - all in Sydney; the Department of Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); the Stroke Trials Unit, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham (P.M.B.), Radcliffe Department of Medicine, University of Oxford, Oxford (G.A.F., N.S.), and the University of Leicester, Leicester (T.R.) - all in the United Kingdom; the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the University of California, Los Angeles, Los Angeles (J.L.S.); and the Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (H.B.W.).
在救护车中早期降低血压并没有改善未分化的急性中风患者的结果. 然而,它有利于出血性中风患者,但恶化了缺血性中风患者的结果.
科学领域:
- 神经学 神经学
- 紧急医疗 紧急医疗
- 心血管研究研究心血管研究
背景情况:
- 在区分缺血型和出血型之前,急性中风的治疗是具有挑战性的.
- 在救护车中对未分化的急性中风进行非常早期的血压控制的有效性仍然不确定.
研究的目的:
- 调查即时的医院前降低血压是否能改善急性中风患者的功能结果.
主要方法:
- 在2404名疑似急性中风和心血压升高 (≥150毫米升) 的患者进行随机试验.
- 干预组在救护车中立即降低了血压 (目标为130-140毫米升);通常护理组接受了标准管理.
- 主要结局是90天后的功能状态 (修改的兰金级);安全结局是严重的不良事件.
主要成果:
- 两组之间功能结果或严重不良事件没有显著差异.
- 医院前血压降低与出血性中风的更好结果有关,但在缺血性中风的结果更差.
结论:
- 在未分化的急性中风患者中,医院前降低血压并没有改善整体功能结果.
- 该策略在出血性中风中显示出潜在的益处,但在缺血性中风中显示出潜在的危害,这凸显了需要仔细选择患者的必要性.


