密集血压管理在血栓溶解后环境中的影响:现实世界的观察研究
Bethan Harper1, Syrah Ranta2, Harry McNaughton3
1Resident Medical Office, Wellington Hospital (at time this work was conducted).
The New Zealand medical journal
|June 6, 2024
概括
在中风血栓溶解后降低缩血压目标显示,高血压事件减少,但低血压事件增加的趋势. 患者的结局没有受到密集血压协议的影响.
科学领域:
- 神经学 神经学
- 心脏病学 心脏病学
- 临床试验 临床试验
背景情况:
- 高静脉压 (SBP) 的中风后血栓溶解与更糟糕的结果有关.
- 目前针对SBP<180mmHg的指导方针可能导致治疗超标.
- 调查较低的SBP目标对于优化血栓溶解后护理至关重要.
研究的目的:
- 评估较低的血栓溶解后SBP目标是否减少高SBP事件.
- 为了比较新的密集性SBP协议 (140-160mmHg) 与基于指南的协议 (<180mmHg).
主要方法:
- 两个血压方案 (2013-2017) 的单中心,顺序比较.
- 主要结局:SBP的比率大于180mmHg.
- 二次结局:SBP <120mmHg,有症状的脑内出血 (sICH) 和3个月的功能独立 (修改的兰金评分[mRS] 0-2).
- 用关键变量回归进行调整分析.
主要成果:
- 密集的SBP协议显示了较少SBP>180mmHg事件的非显著趋势 (aOR 0.61;p=0.14).
- 在密集治疗组中观察到SBP<120mmHg事件的显著增加 (aOR3.09;p=0.002).
- 在不同方案之间,sICH和3个月的mRS 0-2的发病率相似.
结论:
- 密集的血栓溶解后血压方案没有显著减少高SBP事件.
- 密集的治疗方案导致了更多的低血压事件.
- 关于出血和功能独立的患者结果没有受到不利影响.
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