血压对急性后循环脑梗死静脉溶栓效果的影响研究
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摘要
目的探讨不同血压水平对静脉溶栓治疗急性后循环脑梗死时溶栓疗效的影响。方法收集220例首次发病的急性后循环梗死患者,其中男120例,女100例;年龄40～80岁,平均年龄(65.34±5.38)岁。根据患者血压水平分为低血压组和高血压组,分别给2组患者在30 min内静脉滴注溶于100 ml 0.9%氯化钠溶液中的100万U尿激酶,比较2组患者的静脉溶栓效果。结果高血压组治疗有效26(22.6%)例,低血压组治疗有效13(12.4%)例。2组比较差异有统计学意义(P<0.05)。高血压组脑出血3(2.6%)例,低血压组有脑出血2(1.9%)例。2组比较差异无统计学意义(P>0.05)。结论维持合适高的血压水平可以提高急性后循环脑梗死的静脉溶栓成功率,不增加脑出血风险。
Objective To investigate the effects of different blood pressure levels on vein hrombolysis effects in patients with acute posterior circulation cerebral infarction.Methods A total of 220 patients with acute posterior circulation cerebral infarction for the first time including 120 males and 100 females,whose age was 40～80 years,with average age being(65.34±5.38)years. The 220 patients were divided into high blood pressure group and low blood pressure group according to their blood pressure levels.The patients in both groups were treated by intravenous drip of urokinase 1,000,000 U dissolved in 100 ml normal saline within 30 minutes. The venous thrombolysis effects were observed and compared between the two grousp.Results The effective rate in high blood pressure group was 22.6%(26 cases),which was 12.4%(13 cases) in low blood pressure group,and there was significant difference between the two groups(P<0.05).The therapeutic effects in high blood pressure group were superior to those in low blood pressure group.There were 3 cases(2.6%) of erebral hemorrhage in high blood pressure group, and 2 cases(1.9%) in low blood pressure group,and there was no significant difference between the two groups(P>0.05).Conclusion The proper high blood pressure can improve the successful rate of vein thrombolysis in treatment of acute posterior circulation cerebral infarction,without increasing the risk of cerebral hemorrhage.
Objective To investigate the effects of different blood pressure levels on vein hrombolysis effects in patients with acute posterior circulation cerebral infarction.Methods A total of 220 patients with acute posterior circulation cerebral infarction for the first time including 120 males and 100 females,whose age was 40～80 years,with average age being(65.34±5.38)years. The 220 patients were divided into high blood pressure group and low blood pressure group according to their blood pressure levels.The patients in both groups were treated by intravenous drip of urokinase 1,000,000 U dissolved in 100 ml normal saline within 30 minutes. The venous thrombolysis effects were observed and compared between the two grousp.Results The effective rate in high blood pressure group was 22.6%(26 cases),which was 12.4%(13 cases) in low blood pressure group,and there was significant difference between the two groups(P<0.05).The therapeutic effects in high blood pressure group were superior to those in low blood pressure group.There were 3 cases(2.6%) of erebral hemorrhage in high blood pressure group, and 2 cases(1.9%) in low blood pressure group,and there was no significant difference between the two groups(P>0.05).Conclusion The proper high blood pressure can improve the successful rate of vein thrombolysis in treatment of acute posterior circulation cerebral infarction,without increasing the risk of cerebral hemorrhage.
引文
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2 李超平,李递通.急性脑梗死溶栓治疗现状及进展.医学理论与实践,2014,27:305-307.
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10 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010.中华神经科杂志,2010,43:146-153.
11 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2018.中华神经科杂志,2018,51:666-682.
12 Blackham KA,Meyers PM,Abruzzo TA,et al.Endovascular therapy of acute ischemic stroke:report of the Standards of Practice Committee of the Society of Neuro Intervenventional Surgery.J Neurointerv Surg,2012,4:87-93.
13 中国后循环缺血专家共识组.中国后循环缺血专家共识.中华内科杂志,2006,45:786.
14 Powers WJ,Derdeyn CP,Coffey CS,et al.American Heart Association Stroke Couyncil.2015 AHA/ASA focused update of the 2013 guidelines for the early management of management pationts with acute ischemic stroke regarding endovascular treatmnrt.Stroke,2015,46:3020-3035.
15 王眙民,许梅.急性脑梗死溶栓治疗临床研究进展.中国实用医药,2017,12:113-115.
16 黄银辉,林友榆,陈杰,等.rt-PA与尿激酶溶栓治疗急性脑梗塞115例疗效比较.海南医学,2013,24:2979-2982.
17 吴江,贾建平,崔丽英主编.神经病学.第1版.北京:人民卫生出版社,2005.152-162.
18 尹所,张道培,禹萌,等.基底动脉发育不全患者脑干血流动力学的变化及临床意义.中国实用神经疾病杂志,2017,20:18-23.
19 闫燃,任安,黄振国,等.256层CT诊断大脑后循环血管变异及临床应用.中华全科医学,2012,10:624-626.
20 Katsanos AH,kosmidou M,Giannopoulos S.Vertebral artery hypoplasia in posterior circulation cerebral ischemia.Clin Neurol Neurosurg,2013,115:1194-1195.
21 Thierfelder KM,Baumann AB,Sommer WH,et al.Vertebral artery hypoplasia:frequency and effect on cerebellar blood bow characteristics.Stroke,2014,45:1363-1368.
22 杨海鹏,张磊,于寰,等.椎基底动脉系变异与短暂性脑缺血发作的相关性分析.中国CT与MRI杂志,2018,16:46-48.
2 李超平,李递通.急性脑梗死溶栓治疗现状及进展.医学理论与实践,2014,27:305-307.
3 Schulz UG,Fischer U.Posterior circulation cerebrovascular syndromes:diagnosis and management.J Neurol Neurosurg Psychiatry,2016,31:1136-1142.
4 Go S.Posterior circulation ischemic stroke.Missouri Medicine,2015,112:192-196.
5 Savitz SI,Caplan LR.Vertebrobasilar disease.N Engl J Med,2005,352:2618-2626.
6 Cap lan LR,Wityk FJ,Glass TA,et al.New England Medical Center Posterior Circulation registry.Ann Neurol,2004,56:389-398.
7 邹昕颖,恭浠平,潘岳松,等.前、后循环系统脑梗死危险因素和预后的对比研究.中国卒中杂志,2016,11:773-776.
8 王拥军主编.神经内科学高级教程.第1版.北京:人民军医出版社,2016.111-121.
9 中华神经外科学会中华神经科学会.各类脑血管疾病诊断要点.中华神经科杂志,1996,29:379.
10 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010.中华神经科杂志,2010,43:146-153.
11 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2018.中华神经科杂志,2018,51:666-682.
12 Blackham KA,Meyers PM,Abruzzo TA,et al.Endovascular therapy of acute ischemic stroke:report of the Standards of Practice Committee of the Society of Neuro Intervenventional Surgery.J Neurointerv Surg,2012,4:87-93.
13 中国后循环缺血专家共识组.中国后循环缺血专家共识.中华内科杂志,2006,45:786.
14 Powers WJ,Derdeyn CP,Coffey CS,et al.American Heart Association Stroke Couyncil.2015 AHA/ASA focused update of the 2013 guidelines for the early management of management pationts with acute ischemic stroke regarding endovascular treatmnrt.Stroke,2015,46:3020-3035.
15 王眙民,许梅.急性脑梗死溶栓治疗临床研究进展.中国实用医药,2017,12:113-115.
16 黄银辉,林友榆,陈杰,等.rt-PA与尿激酶溶栓治疗急性脑梗塞115例疗效比较.海南医学,2013,24:2979-2982.
17 吴江,贾建平,崔丽英主编.神经病学.第1版.北京:人民卫生出版社,2005.152-162.
18 尹所,张道培,禹萌,等.基底动脉发育不全患者脑干血流动力学的变化及临床意义.中国实用神经疾病杂志,2017,20:18-23.
19 闫燃,任安,黄振国,等.256层CT诊断大脑后循环血管变异及临床应用.中华全科医学,2012,10:624-626.
20 Katsanos AH,kosmidou M,Giannopoulos S.Vertebral artery hypoplasia in posterior circulation cerebral ischemia.Clin Neurol Neurosurg,2013,115:1194-1195.
21 Thierfelder KM,Baumann AB,Sommer WH,et al.Vertebral artery hypoplasia:frequency and effect on cerebellar blood bow characteristics.Stroke,2014,45:1363-1368.
22 杨海鹏,张磊,于寰,等.椎基底动脉系变异与短暂性脑缺血发作的相关性分析.中国CT与MRI杂志,2018,16:46-48.