早期降压治疗对不同TOAST分型AIS合并血压升高患者疗效及预后的影响

Effect of early antihypertensive therapy times on the efficacy and prognosis of patients with different TOAST type AIS complicated with elevated blood pressure

摘要:

目的观察早期降血压治疗对不同TOAST分型急性缺血性脑卒中(AIS)合并血压升高患者疗效及预后的影响。 方法选取AIS患者240例为研究对象,根据TOAST分型分为大动脉粥样硬化脑梗塞(LAA)70例、小动脉闭塞脑梗塞(SAO)66例、心源性脑栓塞(CE)60例、其他(OTH)类型44例,各类型内根据不同降压时间分为24 h、72 h两个亚组,分别于发病24 h、72 h后进行降血压治疗。比较患者治疗后30、60、90天美国国立卫生研究院卒中量表(NIHSS)评分及改良Rankin量表(mRs)评分。出院后随访1年,记录预后不良事件发生情况。 结果治疗后,各分型24 h、72 h组NIHSS及mRS评分均低于治疗前(P＜0.05),CE-72 h亚组的NIHSS评分高于CE-24 h亚组(P＜0.05)。出院后1年内,CE-24 h组致残率显著低于72 h组(P＜0.05)。 结论在CE分型中早期降血压(发病24 h)治疗可降低NIHSS评分及致残率。

Abstract:

To observe the effect of early antihypertensive therapy times on the efficacy and prognosis of patients with different TOAST type acute ischemic stroke (AIS) complicated with elevated blood pressure. MethodsA total of 240 patients with AIS were selected and divided into 70 cases of large arterial atherosclerotic cerebral infarction (LAA), 66 cases of small artery occlusion cerebral infarction (SAO), 60 cases of cardiogenic cerebral embolism (CE), and 44 cases of other types (OTH) according to TOAST classification. Each type was divided into two subgroups 24 h and 72 h according to the random number table method. Antihypertensive treatment was performed 24 h and 72 h after the onset of symptoms. The National Institutes of Health Stroke Scale score (NIHSS) and the modified Rankin scale (mRS) were used to evaluate the curative effect of the patients 30 days, 60 days, and 90 days after treatment. The patients were followed up for 1 year after discharge to observe the incidence of adverse prognostic events. ResultsAfter treatment, the NIHSS and mRS scores in all types and observation points were lower than those before treatment (P＜0.05), and NIHSS scores in CE-72 h subgroup were higher than that in CE-24 h subgroup (P＜0.05). Within 1 year after discharge, the disability rate of CE-24 h group was significantly lower than that of 72 h group (P＜0.05). ConclusionEarly antihypertension (24 h after onset) can reduce NIHSS score and disability rate in patients with CE classification.