颈动脉狭窄并高血压患者血压调控与缺血性卒中的关系探讨

目的:探讨颈动脉狭窄并高血压患者血压调控水平与脑梗死的关系。方法:对血压超过160/100mmHg且一个月以内血压控制欠理想的颈动脉狭窄患者168例,随机分A、B组,A组血压控制在140~160/90~100mmHg,B组控制在110~140/75~90mmHg,随访两年,观察两组缺血性卒中的例数、卒中类型及狭窄部位。结果:A组82例,B组86例,A组前3个月发生梗死的例数比B组少且有统计学意义,随访2年后,两组无差异;导致缺血性卒中相关侧狭窄的好发部位,依次是大脑中动脉>颈内动脉颅外段>颈内动脉颅内段;在缺血性卒中类型中,A组以动脉粥样硬化性脑梗死和腔隙性梗死多见,B组以短暂性脑缺血发作(TIA)和分水岭梗死多见,但无统计学意义。结论:颈动脉狭窄并高血压患者血压维持在较高水平短期内可以减少缺血性卒中的发生,但长期随访并无获益;卒中类型以动脉粥样硬化性脑梗死和腔隙性梗死多见。

The Relationship between Blood Pressure Regulation and Ischemic Stroke in Patients with Carotid Stenosis and Hypertension

Objective To explore the relationship between blood pressure regulation and ischemic stroke in hypertension patients with carotid stenosis. Methods 168 hypertension patients with carotid stenosis, whose blood pressure 〉 160/100 mmHg and with unsatisfied blood pressure control more than one month were randomly divided into A, B groups. The blood pressure of patients in A group （82 cases） was controlled at 140/90mmHg- 160/100mmHg, while B group （86 cases） at 110/75mmHg - 140/90mmHg. During two-year＇s follow-up, the ischemic stroke incidence, stroke types and stenosis site were observed and recorded for these two groups. Results During the first 3 months of study, the stroke incidence in A group was significantly lower than that in B group, while there was no difference in the stroke incidence between two groups at the end of two year＇s follow-up. The relevant artery stenosis leading to ischemie stroke was arteria cerebri media 〉 extracranial segrnenfi of arteria carotis intema 〉 intercranial segmenti of arteria earotis interna. Among the stroke types, A group was found mostly with atherosclerosis cerebral infarction and lacunar infarction, B group was found mostly with TIA and cerebral watershed infarction, but them was no statistical difference. Conclusions Our study indicated that for hypertension patients with carotid stenosis the blood pressure should be lowered slowly to reach a certain lever in order to establish cerebrovaseular compensation to decrease ischemic stroke.