目的 探索缺血性腦卒中患者溶栓前血壓管理和預后的相關性，并分析溶栓前血壓管理考慮顱內外血管狀態的必要性。 方法 計算機檢索PUBMED數據庫，并輔以其他檢索，對所有涉及溶栓前血壓的文獻進行整理，并根據“溶栓類型、是否進行溶栓前血壓管理、是否進行溶栓前血管評估”對文獻進行分類，對其溶栓后的癥狀性顱內出血率進行分析對比。 結果 大多數靜脈溶栓文獻無血管評估的數據，其出血率波動于較高水平；進行了血管評估，而未提及血壓管理或雖未進行血壓管理，但所有患者的血壓符合指南中對于血壓的要求的文獻也呈現了較高的出血率；有1篇進行了血管評估的動脈溶栓文獻沒有癥狀性顱內出血事件發生。 結論 當前證據表明現有的溶栓前血壓管理模式還不夠完善，這也在一定程度上可以解釋目前較高的溶栓后癥狀性出血率。合理的溶栓前血壓管理模式有待進一步探索。溶栓前血壓管理考慮顱內外血管狀態，根據血管病變程度對溶栓前血壓進行分級管理可能會成為一個較佳的血壓管理模式。
引用本文： 趙晶晶,陳寧,何俐. 缺血性腦卒中患者溶栓前血壓管理現狀分析. 華西醫學, 2013, 28(5): 647-650. doi: 10.7507/1002-0179.20130206 復制
| 1. | Walt G. Who’s world health report 2003[J]. BMJ, 2004, 328(7430): 6. |
| 2. | Diez-Tejedor E, Fuentes B. Acute care in stroke: The importance of early intervention to achieve better brain protection[J]. Cerebrovasc Dis, 2004, 17 (Suppl 1): 130-137. |
| 3. | Baird AE, Austin MC, McKay WJ, et al. Changes in cerebral tissue perfusion during the first 48 hours of ischaemic stroke: Relation to clinical outcome[J]. J Neurol Neurosurg Psychiatry, 1996, 61(1): 26-29. |
| 4. | Albright KC, Schott TC, Jafari N, et al. Tissue plasminogen activator use: Evaluation and initial management of ischemic stroke from an iowa hospital perspective[J]. J Stroke Cerebrovasc Dis, 2005, 14(3): 127-135. |
| 5. | Adams HP Jr, Brott TG, Furlan AJ, et al. Guidelines for thrombolytic therapy for acute stroke: A supplement to the guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the stroke council, american heart association[J]. Circulation, 1996, 94(5): 1167-1174. |
| 6. | Lansberg MG, Albers GW, Wijman CA. Symptomatic intracerebral hemorrhage following thrombolytic therapy for acute ischemic stroke: A review of the risk factors[J]. Cerebrovasc Dis, 2007, 24(1): 1-10. |
| 7. | Perini F, De Boni A, Marcon M, et al. Systolic blood pressure contributes to intracerebral haemorrhage after thrombolysis for ischemic stroke[J]. J Neurol Sci, 2010, 297(1-2): 52-54. |
| 8. | Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the american heart association/american stroke association stroke council, clinical cardiology council, cardiovascular radiology and intervention council, and the atherosclerotic peripheral vascular disease and quality of care outcomes in research interdisciplinary working groups: The american academy of neurology affirms the value of this guideline as an educational tool for neurologists[J]. Circulation, 2007, 115(20): 478-534. |
| 9. | Tsivgoulis G, Frey JL, Flaster M, et al. Pre-tissue plasminogen activator blood pressure levels and risk of symptomatic intracerebral hemorrhage[J]. Stroke, 2009, 40(11): 3631-3634. |
| 10. | Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment: Pooled analysis of atlantis, ecass, and ninds rt-pa stroke trials[J]. Lancet, 2004, 363(9411): 768-774. |
| 11. | Derex L, Hermier M, Adeleine P, et al. Clinical and imaging predictors of intracerebral haemorrhage in stroke patients treated with intravenous tissue plasminogen activator[J]. J Neurol Neurosurg Psychiatry, 2005, 76(1): 70-75. |
| 12. | Gilligan AK, Markus R, Read S, et al. Baseline blood pressure but not early computed tomography changes predicts major hemorrhage after streptokinase in acute ischemic stroke[J]. Stroke, 2002, 33(9): 2236-2242. |
| 13. | Harrington C. Managing hypertension in patients with stroke. Are you prepared for labetalol infusion?[J]. Crit Care Nurse, 2003, 23(3): 30-38. |
| 14. | Strandgaard S, Paulson OB. Cerebral autoregulation[J]. Stroke, 1984, 15(3): 413-416. |
| 15. | Brott T, Lu M, Kothari R, et al. Hypertension and its treatment in the ninds rt-pa stroke trial[J]. Stroke, 1998, 29(8): 1504-1509. |
| 16. | Martin-Schild S, Hallevi H, Albright KC, et al. Aggressive blood pressure-lowering treatment before intravenous tissue plasminogen activator therapy in acute ischemic stroke[J]. Arch Neurol, 2008, 65(9): 1174-1178. |
| 17. | Ahmed N, Wahlgren N, Brainin M, et al. Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis: retrospective analysis from safe implementation of thrombolysis in stroke-international stroke thrombolysis register (sits-istr) [J]. Stroke, 2009, 40(7): 2442-2449. |
| 18. | Dharmasaroja PA, Dharmasaroja P, Muengtaweepongsa S. Outcomes of thai patients with acute ischemic stroke after intravenous thrombolysis[J]. J Neurol Sci, 2011, 300(1-2): 74-77. |
| 19. | Lindsberg PJ, Soinne L, Roine RO, et al. Community-based thrombolytic therapy of acute ischemic stroke in helsinki[J]. Stroke, 2003, 34(6): 1443-1449. |
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| 21. | Linfante I, Llinas RH, Selim M, et al. Clinical and vascular outcome in internal carotid artery versus middle cerebral artery occlusions after intravenous tissue plasminogen activator[J]. Stroke, 2002, 33(8):2066-2071. |
| 22. | Molina CA, Alexandrov AV, Demchuk AM, et al. Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator[J]. Stroke, 2004, 35(1): 151-156. |
| 23. | Saqqur M, Uchino K, Demchuk AM, et al. Site of arterial occlusion identified by transcranial doppler predicts the response to intravenous thrombolysis for stroke[J]. Stroke, 2007, 38(3): 948-954. |
| 24. | Delgado-Mederos R, Ribo M, Rovira A, et al. Prognostic significance of blood pressure variability after thrombolysis in acute stroke[J]. Neurology, 2008, 71(8): 552-558. |
| 25. | Molina CA, Barreto AD, Tsivgoulis G, et al. Transcranial ultrasound in clinical sonothrombolysis (tucson) trial[J]. Ann Neurol, 2009, 66(1): 28-38. |
| 26. | Ibrahim MM, Sebastian J, Hussain M, et al. Does current oral antiplatelet agent or subtherapeutic anticoagulation use have an effect on tissue-plasminogen-activator-mediated recanalization rate in patients with acute ischemic stroke?[J]. Cerebrovasc Dis, 2010, 30(5): 508-513. |
| 27. | Delgado MG, Michel P, Naves M, et al. Early profiles of clinical evolution after intravenous thrombolysis in an unselected stroke population[J]. J Neurol Neurosurg Psychiatry, 2010, 81(3): 282-285. |
| 28. | Saqqur M, Tsivgoulis G, Molina CA, et al. Symptomatic intracerebral hemorrhage and recanalization after iv rt-pa: A multicenter study[J]. Neurology, 2008, 71(17): 1304-1312. |
| 29. | Selim M, Fink JN, Kumar S, et al. Predictors of hemorrhagic transformation after intravenous recombinant tissue plasminogen activator: Prognostic value of the initial apparent diffusion coefficient and diffusion-weighted lesion volume[J]. Stroke, 2002, 33(8): 2047-2052. |
| 30. | Christou I, Alexandrov AV, Burgin WS, et al. Timing of recanalization after tissue plasminogen activator therapy determined by transcranial doppler correlates with clinical recovery from ischemic stroke[J]. Stroke, 2000, 31(8): 1812-1816. |
| 31. | Tsivgoulis G, Saqqur M, Sharma VK, et al. Association of pretreatment blood pressure with tissue plasminogen activator-induced arterial recanalization in acute ischemic stroke[J]. Stroke, 2007, 38(3): 961-966. |
| 32. | Takada T, Yasaka M, Minematsu K, et al. Predictors of clinical outcome in patients receiving local intra-arterial thrombolysis without subsequent symptomatic intracranial hemorrhage against acute middle cerebral artery occlusion[J]. AJNR Am J Neuroradiol, 2004, 25(10): 1796-1801. |
| 33. | Alexandrov AV, Molina CA, Grotta JC, et al. Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke[J]. N Engl J Med, 2004, 351(21): 2170-2178. |
| 34. | Latchaw RE, Alberts MJ, Lev MH, et al. Recommendations for imaging of acute ischemic stroke: A scientific statement from the american heart association[J]. Stroke, 2009, 40(11): 3646-3678. |
| 35. | Alexandrov AV, Demchuk AM, Wein TH, et al. Yield of transcranial doppler in acute cerebral ischemia[J]. Stroke, 1999, 30(8): 1604-1609. |
| 36. | Chernyshev OY, Garami Z, Calleja S, et al. Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia[J]. Stroke, 2005, 36(1): 32-37. |
- 1. Walt G. Who’s world health report 2003[J]. BMJ, 2004, 328(7430): 6.
- 2. Diez-Tejedor E, Fuentes B. Acute care in stroke: The importance of early intervention to achieve better brain protection[J]. Cerebrovasc Dis, 2004, 17 (Suppl 1): 130-137.
- 3. Baird AE, Austin MC, McKay WJ, et al. Changes in cerebral tissue perfusion during the first 48 hours of ischaemic stroke: Relation to clinical outcome[J]. J Neurol Neurosurg Psychiatry, 1996, 61(1): 26-29.
- 4. Albright KC, Schott TC, Jafari N, et al. Tissue plasminogen activator use: Evaluation and initial management of ischemic stroke from an iowa hospital perspective[J]. J Stroke Cerebrovasc Dis, 2005, 14(3): 127-135.
- 5. Adams HP Jr, Brott TG, Furlan AJ, et al. Guidelines for thrombolytic therapy for acute stroke: A supplement to the guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the stroke council, american heart association[J]. Circulation, 1996, 94(5): 1167-1174.
- 6. Lansberg MG, Albers GW, Wijman CA. Symptomatic intracerebral hemorrhage following thrombolytic therapy for acute ischemic stroke: A review of the risk factors[J]. Cerebrovasc Dis, 2007, 24(1): 1-10.
- 7. Perini F, De Boni A, Marcon M, et al. Systolic blood pressure contributes to intracerebral haemorrhage after thrombolysis for ischemic stroke[J]. J Neurol Sci, 2010, 297(1-2): 52-54.
- 8. Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the american heart association/american stroke association stroke council, clinical cardiology council, cardiovascular radiology and intervention council, and the atherosclerotic peripheral vascular disease and quality of care outcomes in research interdisciplinary working groups: The american academy of neurology affirms the value of this guideline as an educational tool for neurologists[J]. Circulation, 2007, 115(20): 478-534.
- 9. Tsivgoulis G, Frey JL, Flaster M, et al. Pre-tissue plasminogen activator blood pressure levels and risk of symptomatic intracerebral hemorrhage[J]. Stroke, 2009, 40(11): 3631-3634.
- 10. Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment: Pooled analysis of atlantis, ecass, and ninds rt-pa stroke trials[J]. Lancet, 2004, 363(9411): 768-774.
- 11. Derex L, Hermier M, Adeleine P, et al. Clinical and imaging predictors of intracerebral haemorrhage in stroke patients treated with intravenous tissue plasminogen activator[J]. J Neurol Neurosurg Psychiatry, 2005, 76(1): 70-75.
- 12. Gilligan AK, Markus R, Read S, et al. Baseline blood pressure but not early computed tomography changes predicts major hemorrhage after streptokinase in acute ischemic stroke[J]. Stroke, 2002, 33(9): 2236-2242.
- 13. Harrington C. Managing hypertension in patients with stroke. Are you prepared for labetalol infusion?[J]. Crit Care Nurse, 2003, 23(3): 30-38.
- 14. Strandgaard S, Paulson OB. Cerebral autoregulation[J]. Stroke, 1984, 15(3): 413-416.
- 15. Brott T, Lu M, Kothari R, et al. Hypertension and its treatment in the ninds rt-pa stroke trial[J]. Stroke, 1998, 29(8): 1504-1509.
- 16. Martin-Schild S, Hallevi H, Albright KC, et al. Aggressive blood pressure-lowering treatment before intravenous tissue plasminogen activator therapy in acute ischemic stroke[J]. Arch Neurol, 2008, 65(9): 1174-1178.
- 17. Ahmed N, Wahlgren N, Brainin M, et al. Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis: retrospective analysis from safe implementation of thrombolysis in stroke-international stroke thrombolysis register (sits-istr) [J]. Stroke, 2009, 40(7): 2442-2449.
- 18. Dharmasaroja PA, Dharmasaroja P, Muengtaweepongsa S. Outcomes of thai patients with acute ischemic stroke after intravenous thrombolysis[J]. J Neurol Sci, 2011, 300(1-2): 74-77.
- 19. Lindsberg PJ, Soinne L, Roine RO, et al. Community-based thrombolytic therapy of acute ischemic stroke in helsinki[J]. Stroke, 2003, 34(6): 1443-1449.
- 20. Alexandrov AV, Demchuk AM, Felberg RA, et al. High rate of complete recanalization and dramatic clinical recovery during tpa infusion when continuously monitored with 2-mhz transcranial doppler monitoring[J]. Stroke, 2000, 31(3): 610-614.
- 21. Linfante I, Llinas RH, Selim M, et al. Clinical and vascular outcome in internal carotid artery versus middle cerebral artery occlusions after intravenous tissue plasminogen activator[J]. Stroke, 2002, 33(8):2066-2071.
- 22. Molina CA, Alexandrov AV, Demchuk AM, et al. Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator[J]. Stroke, 2004, 35(1): 151-156.
- 23. Saqqur M, Uchino K, Demchuk AM, et al. Site of arterial occlusion identified by transcranial doppler predicts the response to intravenous thrombolysis for stroke[J]. Stroke, 2007, 38(3): 948-954.
- 24. Delgado-Mederos R, Ribo M, Rovira A, et al. Prognostic significance of blood pressure variability after thrombolysis in acute stroke[J]. Neurology, 2008, 71(8): 552-558.
- 25. Molina CA, Barreto AD, Tsivgoulis G, et al. Transcranial ultrasound in clinical sonothrombolysis (tucson) trial[J]. Ann Neurol, 2009, 66(1): 28-38.
- 26. Ibrahim MM, Sebastian J, Hussain M, et al. Does current oral antiplatelet agent or subtherapeutic anticoagulation use have an effect on tissue-plasminogen-activator-mediated recanalization rate in patients with acute ischemic stroke?[J]. Cerebrovasc Dis, 2010, 30(5): 508-513.
- 27. Delgado MG, Michel P, Naves M, et al. Early profiles of clinical evolution after intravenous thrombolysis in an unselected stroke population[J]. J Neurol Neurosurg Psychiatry, 2010, 81(3): 282-285.
- 28. Saqqur M, Tsivgoulis G, Molina CA, et al. Symptomatic intracerebral hemorrhage and recanalization after iv rt-pa: A multicenter study[J]. Neurology, 2008, 71(17): 1304-1312.
- 29. Selim M, Fink JN, Kumar S, et al. Predictors of hemorrhagic transformation after intravenous recombinant tissue plasminogen activator: Prognostic value of the initial apparent diffusion coefficient and diffusion-weighted lesion volume[J]. Stroke, 2002, 33(8): 2047-2052.
- 30. Christou I, Alexandrov AV, Burgin WS, et al. Timing of recanalization after tissue plasminogen activator therapy determined by transcranial doppler correlates with clinical recovery from ischemic stroke[J]. Stroke, 2000, 31(8): 1812-1816.
- 31. Tsivgoulis G, Saqqur M, Sharma VK, et al. Association of pretreatment blood pressure with tissue plasminogen activator-induced arterial recanalization in acute ischemic stroke[J]. Stroke, 2007, 38(3): 961-966.
- 32. Takada T, Yasaka M, Minematsu K, et al. Predictors of clinical outcome in patients receiving local intra-arterial thrombolysis without subsequent symptomatic intracranial hemorrhage against acute middle cerebral artery occlusion[J]. AJNR Am J Neuroradiol, 2004, 25(10): 1796-1801.
- 33. Alexandrov AV, Molina CA, Grotta JC, et al. Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke[J]. N Engl J Med, 2004, 351(21): 2170-2178.
- 34. Latchaw RE, Alberts MJ, Lev MH, et al. Recommendations for imaging of acute ischemic stroke: A scientific statement from the american heart association[J]. Stroke, 2009, 40(11): 3646-3678.
- 35. Alexandrov AV, Demchuk AM, Wein TH, et al. Yield of transcranial doppler in acute cerebral ischemia[J]. Stroke, 1999, 30(8): 1604-1609.
- 36. Chernyshev OY, Garami Z, Calleja S, et al. Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia[J]. Stroke, 2005, 36(1): 32-37.