高收缩压水平脑分水岭梗死急性期升压治疗对预后影响的前瞻性研究

目的 探讨升压治疗对收缩压（systolic blood pressure，SBP）在140～160 mmHg的急性脑分水岭梗死患者预后的影响。方法 本研究为前瞻性研究，连续选择2011年l月至2014年11月同济大学附属同济医院神经内科首次发病48 h内SBP在140～160 mmHg的急性脑分水岭梗死患者64例，分为升压治疗组29例和常规治疗组35例，升压治疗组除阿司匹林、阿托伐他汀等常规治疗外加用多巴胺升压治疗，使SBP较入院时血压上升约20 mmHg，维持3天。于入院时和2周采用美国国立卫生研究院卒中量表（National Institute ofHealth Stroke Scale，NIHSS）评分、发病后6个月采用改良Rankin量表（modified Rankin Scale，mRS）评分对患者神经功能缺损评价，NIHSS减少46%以上视为升压治疗显效；mRS≤2分为预后良好。结果 两组患者入院时年龄、性别、发病时间和NIHSS评分等基线资料差异无显著性，入院2周时升压治疗组显效率为27.6%，与常规治疗组的28.6%比较差异无显著性（P =0.930）。发病6个月升压治疗组预后良好率为65.5%，高于常规治疗组的48.6%，但差异无显著性（P =0.174）。结论 升压治疗对SBP在140～160 mmHg的急性脑分水岭梗死患者无明显疗效。

Effect of Elevated Blood Pressure Treatment on Outcome of Acute Watershed Infarction with High Systolic Blood Pressure Levels

Objective To investigate the effect of elevated blood pressure(BP) on outcome of patients with
acute cerebral watershed infarction(CWI) with systolic blood pressure(SBP) range from 140 to 160
mmHg.
Methods Sixty-four successive patients with first onset acute CWI with SBP range from 140 to
160 mmHg were enrolled in this prospective analysis, which was from department of neurology,
Tongji hospital, Tongji University between January 2011 and November 2014. Patients were
randomly divided into elevated BP treatment group(treatment group, 29 cases) and routine
treatment group(routine group, 35 cases), Dopamine was given to elevate SBP about 20 mmHg
in the treatment group besides routine ischemic stroke therapy including Aspirin and Atorvastatin
etc. in the first three days after admission. National Institutes of Health Stroke Scale(NIHSS) were
recorded at admission and 2 weeks after admission or at discharge, modified Rankin Score(mRS)
was collected for assessment of neurological function defect at 6 months after stroke. More than
46% decrease of NIHSS was defined as effectivity of elevated BP treatment 2 weeks after admission
or at discharge, and mRS≤2 was defined as good outcome.
Results There was no difference in baseline data including age, sex, disease time and NIHSS,
etc. between two groups. The effective rate was 27.6% in treatment group and 28.6% in routine
group 2 weeks after admission or at discharge. There was no statistic significance between twogroups(P =0.930). The proportion of good outcome was higher in treatment group(65.5%) than in
routine group(48.6%) at six months after stroke, but there was no statistic significance(P =0.174).
Conclusion Elevated BP treatment had no effect on obvious outcome in the patients with acute
CWI with SBP ranged from 140 to 160 mmHg.