摘要：

目的: 探讨强化降压对急性重症缺血性卒中患者血管再通治疗预后的影响。方法: 选择2024年3月至2025年5月在华北理工大学附属医院诊断与治疗的128例急性重症缺血性卒中患者，血管再通治疗后随机予以强化降压（收缩压120 ~ 139 mm Hg，63例）和常规降压（收缩压140 ~ 180 mm Hg，65例），分别于治疗前及降压治疗后1、7和30 d采用美国国立卫生研究院卒中量表（NIHSS）评估神经功能缺损程度，降压治疗后90 d采用改良Rankin量表（mRS）评估神经功能预后，并记录降压治疗后14 d内不良事件发生率和降压治疗后90 d病死率。结果: 强化降压组较常规降压组NIHSS评分降低（F = 10.924，P = 0.001）；两组降压治疗前后NIHSS评分差异有统计学意义（F = 4945.477，P = 0.000），强化降压组和常规降压组治疗后1 d（t = 9.115，P = 0.000；t = 6.984，P = 0.000）、7 d（t = 13.012，P = 0.000；t = 11.855，P = 0.000）和30 d（t = 22.906，P = 0.000；t = 22.720，P = 0.000）NIHSS评分均低于治疗前，治疗后7 d（t = 3.577，P = 0.000；t = 3.413，P = 0.001）和30 d（t = 18.149，P = 0.000；t = 14.893，P = 0.000）均低于治疗后1 d，治疗后30 d亦低于治疗后7 d（t = 14.700，P = 0.000；t = 14.338，P = 0.000）。强化降压组预后良好（mRS评分0 ~ 2分）率高于常规降压组[50.79%（32/63）对32.31%（21/65）；χ² = 4.506，P = 0.034]，两组患者降压治疗14 d内不良事件发生率和降压治疗后90 d病死率差异无统计学意义（均P > 0.05）。结论: 急性重症缺血性卒中患者血管再通治疗后控制收缩压于120 ~ 139 mm Hg，神经功能恢复和预后更佳，且强化降压治疗后不良事件发生率和病死率与常规降压相当。

关键词: 缺血性卒中, 血栓溶解疗法, 血栓切除术, 血压, 预后

Abstract:

Objective: To explore the effect of intensive blood pressure control on the prognosis in patients with acute severe ischemic stroke after revascularization therapy. Methods: Total 128 patients with acute severe ischemic stroke treated in North China University of Science and Technology Affiliated Hospital from March 2024 to May 2025 were enrolled. After revascularization therapy, they were randomly divided into 2 groups: 63 patients received intensive blood pressure control with systolic blood pressure (SBP) maintained at 120-139 mm Hg, and 65 patients received standard blood pressure control with SBP of 140-180 mm Hg. The National Institutes of Health Stroke Scale (NIHSS) was adopted to assess neurological deficit at admission and 1, 7 and 30 d after blood pressure control treatment. The modified Rankin Scale (mRS) was used to evaluate neurological prognosis at 90 d. Meanwhile, the incidence of adverse events within 14 d and 90-day mortality were recorded. Results: Intensive blood pressure control group presented lower NIHSS score than standard blood pressure control group (F = 10.924, P = 0.001). Both groups exhibited prominent changes in NIHSS score before and after intervention (F = 4945.477, P =0.000). Compared with baseline level, NIHSS score declined at 1 d (t = 9.115, P = 0.000; t = 6.984, P = 0.000), 7 d (t = 13.012, P = 0.000; t = 11.855, P = 0.001), and 30 d (t = 22.906, P = 0.000; t = 22.720, P = 0.001) in 2 groups. The NIHSS score at 7 d (t = 3.577, P = 0.000; t = 3.413, P = 0.001) and 30 d (t = 18.149, P = 0.000; t = 14.893, P = 0.000) were lower than those at 1 d in 2 groups. Moreover, the NIHSS score 30 d were significantly lower than those at 7 d in both groups (t = 14.700, P = 0.000; t = 14.338, P = 0.001). A higher proportion of patients achieved favorable prognosis with mRS score of 0-2 in intensive blood pressure control group relative to standard blood pressure control group [50.79% (32/63) vs. 32.31% (21/65); χ² = 4.506, P = 0.034]. No remarkable differences were observed regarding the incidence of adverse events within 14 d and 90-day mortality in 2 groups. Conclusions: Controlling SBP at 120-139 mm Hg after revascularization therapy in patients with acute severe ischemic stroke contributes to better neurological recovery and clinical prognosis. The incidence of adverse events and mortality were comparable between intensive blood pressure control and standard blood pressure control strategies.

Key words: Ischemic stroke, Thrombolytic therapy, Thrombectomy, Blood pressure, Prognosis

中图分类号: 

• R741