Mistri Amit K, Robinson Thompson G, Potter John F
University of Leicester, The Glenfield Hospital, Leicester, UK.
Stroke. 2006 Jun;37(6):1565-71. doi: 10.1161/01.STR.0000222002.57530.05. Epub 2006 May 4.
Systolic blood pressure (SBP) levels below 140 mm Hg after acute stroke occur in 18% to 25% of patients, and may be associated with adverse outcome, in terms of death and disability. It has thus been proposed that BP elevation in acute ischemic stroke may be beneficial by increasing perfusion to the peri-infarct penumbra, though not only in those with low BP levels.
All articles studying BP elevation in the context of acute stroke were identified using a structured search strategy.
Two reviewers independently searched the databases, and 12 relevant publications were identified. All identified publications related to acute ischemic stroke and no articles on pressor therapy in primary hemorrhagic stroke were found. The review included 319 subjects (age: 42 to 88 years, 46% male), with phenylephrine being the most commonly used pressor agent, though 8 studies incorporated volume expansion. Because of small numbers, and varying entry/outcome criteria, no meta-analysis of outcome measures was possible. Overall, in these few studies undertaken, pressor therapy in acute stroke appears feasible and well-tolerated. The benefit and risks in terms of clinical outcomes remains unknown, but intensive monitoring is advised if such therapy is undertaken.
Theoretical arguments exist for inducing BP elevation in acute ischemic stroke to increase blood flow to the ischemic penumbra across patients with a broad BP range. To date, there have only been a few small trials with inconclusive results. Many questions are still unanswered about the safety and potential benefits of pressor therapy in acute stroke. Hopefully, ongoing trials will answer some of these important questions.
急性卒中后收缩压（SBP）低于140 mmHg的情况出现在18%至25%的患者中，就死亡和残疾而言，这可能与不良预后相关。因此有人提出，急性缺血性卒中时血压升高可能通过增加梗死周边半暗带的灌注而有益，尽管不仅适用于血压水平低的患者。
采用结构化检索策略识别所有研究急性卒中时血压升高情况的文章。
两名审阅者独立检索数据库，识别出12篇相关出版物。所有识别出的出版物均与急性缺血性卒中相关，未发现关于原发性出血性卒中升压治疗的文章。该综述纳入了319名受试者（年龄：42至88岁，46%为男性），去氧肾上腺素是最常用的升压药物，不过有8项研究采用了扩容治疗。由于样本量小且纳入/结局标准各异，无法对结局指标进行荟萃分析。总体而言，在这些为数不多的研究中，急性卒中的升压治疗似乎可行且耐受性良好。临床结局方面的获益和风险尚不清楚，但如果进行此类治疗，建议进行密切监测。
对于在急性缺血性卒中时升高血压以增加不同血压范围患者缺血半暗带的血流，存在理论依据。迄今为止，仅有少数小型试验，结果尚无定论。关于急性卒中升压治疗的安全性和潜在获益，仍有许多问题未得到解答。希望正在进行的试验能回答其中一些重要问题。
