共查询到20条相似文献，搜索用时 15 毫秒
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Rebecca S.Y. Teng Benjamin Y.Q. Tan Samuel Miny Nicholas L. Syn Andrew F.W. Ho Nicholas J.H. Ngiam Leonard L.L. Yeo Andrew M. Choong Vijay K. Sharma 《Journal of stroke and cerebrovascular diseases》2019,28(4):906-919
Background
Blood pressure (BP) is an important determinant of functional outcome in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (IV-tPA). Current guidelines recommend a BP target of 185/110 mmHg before IV-tPA bolus and maintaining it at less than 180/105 mmHg for the first 24 hours. However, the effect of blood pressure on various outcome measures after systemic thrombolysis remains unclear.Methods
Following a systematic search of Medline and EMBASE, all observational studies reporting effect of pretreatment BP on 90-day functional outcome as measured by the modified Rankin Scale (mRS) and/ or incidence of symptomatic intracranial hemorrhage (sICH) in AIS patients receiving thrombolytic therapy were included.Results
Of 2181 studies screened, 26 studies, involving 38,937 subjects, met inclusion criteria. Higher prethrombolysis systolic BP was significantly-associated with poorer 90-day functional outcome (Mean difference 3.87 mmHg; 95% confidence interval [CI] 1.18-6.56) and increased incidence of sICH (Mean difference 5.31; 95% CI 2.22-8.40). When studies were stratified by different cut-offs for functional outcome (mRS 0-1 versus 0-2) and definitions of sICH used (Randomized controlled trials or SITS-MOST), there was no significant difference in mean difference between the subgroups.Conclusions
Our data showed that higher prethrombolysis SBP was associated with poorer outcomes in thrombolysed acute ischemic stroke patients. This may suggest that more aggressive lowering of BP below the current recommendations prior to thrombolysis could be beneficial. The effect of early BP trends after tPA infusion could not be evaluated due to limited available data. Ongoing randomized clinical trials, like ENCHANTED, may provide further insights into the current guidelines and optimal BP levels. 相似文献7.
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Réza Behrouz Jaime Masjuán-Vallejo Rocío Vera Joshua Z. Willey Mickael Zedet Solène Moulin Charlotte Cordonnier Catharina J.M. Klijn Karin Kanselaar Maaike Dirks Brian Silver Muhib Khan Mahmoud R. Azarpazhooh Daniel A. Godoy Christine Roffe Lizz Paley Benjamin D. Bray Craig J. Smith Mario Di Napoli 《Journal of stroke and cerebrovascular diseases》2018,27(1):246-256
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目的 探讨中国人群中首发和复发缺血性脑血管病患者的临床特征和卒中结局差异。
方法 本研究基于全国多中心前瞻性中国国家卒中登记研究Ⅲ（the third China national stroke
regi stry,CNSR-Ⅲ）,连续纳入2015年8月-2018年3月急性缺血性卒中或TIA患者,收集人口学信息、血
管危险因素、既往用药史及病因分型系统（causative classification system,CCS）等临床资料,记录随
访3个月和1年时卒中结局。卒中结局包括卒中复发（缺血性卒中或出血性卒中）、联合血管事件（卒中、
心肌梗死及血管性死亡事件）、脑血管病源性死亡及不良功能结局（mRS＞2分）。依据患者既往是否
有卒中病史分为有卒中病史组和无卒中病史组,比较两组的临床特征及卒中结局差异,并分析卒中病
史与卒中结局间的关系。
结果 最终纳入15 166例患者,平均年龄62.2±11.3岁,其中女性4802例（31.7%）;有卒中病史患者
3355例,无卒中病史患者11 811例。有卒中病史组患者年龄,冠心病、高血压、脂代谢紊乱、糖尿病、心
房颤动比例,既往用药史比例、入院NIHSS评分、住院期间降糖和降压治疗比例均高于无卒中病史组,
目前吸烟和重度饮酒比例、入院时LDL-C水平及住院期间抗血小板治疗比例低于无卒中病史组,差
异均有统计学意义。两组CCS分型的分布差异有统计学意义,其中有卒中病史组大动脉粥样硬化型和
心源性栓塞型卒中比例高于无卒中病史组。多因素分析结果显示,卒中病史是随访3个月不良功能结
局（校正OR 1.25,95%CI 1.09～1.44,P =0.002）,随访1年卒中复发（校正HR 1.44,95%CI 1.25～1.67,
P＜0.001）、联合血管事件（校正HR 1.43,95%CI 1.24～1.64,P＜0.001）、脑血管病源性死亡（校正
HR 1.42,95%CI 1.12～1.80,P =0.004）、不良功能结局（校正OR 1.63,95%CI 1.42～1.88,P＜0.001）的
危险因素。
结论 有无卒中病史的缺血性卒中患者的临床特征及随访结局差异较大,尽管患者进行卒中二级
预防治疗,卒中病史仍然是患者1年卒中复发、联合血管事件、脑血管病源性死亡及不良功能结局的
危险因素。 相似文献
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Jeremy A. Miles Leonid Garber Subha Ghosh Daniel M. Spevack 《Journal of stroke and cerebrovascular diseases》2018,27(11):2943-2950