Idicula Titto T, Waje-Andreassen Ulrike, Brogger Jan, Naess Halvor, Lundstadsveen Maria Therese, Thomassen Lars
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
J Stroke Cerebrovasc Dis. 2008 May-Jun;17(3):141-6. doi: 10.1016/j.jstrokecerebrovasdis.2008.01.010.
Body temperature, blood glucose, and blood pressure (BP) may interfere with outcome in patients with acute ischemic stroke treated with thrombolysis.
We prospectively studied 127 patients who received thrombolysis with tissue plasminogen activator for acute stroke in Bergen, Norway. Body temperature, blood glucose, and BP were measured before thrombolysis. Maximum body temperature and maximum blood glucose within the first 5 days after thrombolysis and maximum BP within the first 24 hours after thrombolysis were measured. The outcome was measured with modified Rankin scale score obtained at 3 months after stroke onset. Variables were tested using multiple logistic regression analysis after adjusting for National Institute of Health Stroke Scale score before thrombolysis and potential confounders.
The average age of the patients was 63 years and the median National Institute of Health Stroke Scale score was 13. On admission, diabetes mellitus was present in 6% of patients and hypertension in 51% of patients. High body temperature and high blood glucose after thrombolysis were associated with poor prognosis (odds ratio [OR] 2.84, 95% confidence interval [CI] 1.29-6.25, P = .01; OR 1.33, 95% CI 1.02-1.74, P = .03). High body temperature and high blood glucose before thrombolysis were not associated with outcome (OR 0.79, 95% CI 0.39-1.58, P = .5; OR 1.04, 95% CI 0.75-1.20, P = .08). High systolic BP both before and after thrombolysis was associated with poor outcome (OR 1.27, 95% CI 1.03-1.52, P = .025; OR 1.22, 95% CI 1.00-1.44, P = .045). High diastolic BP both before and after thrombolysis was not associated with outcome (OR 1.03, 95% CI 0.97-1.36, P =.85; OR 1.16, 95% CI 0.99-1.46, P = .29).
The current study indicates that in patients with ischemic stroke, high body temperature and high blood glucose after thrombolysis are associated with poor prognosis. Frequent monitoring of these parameters and the appropriate treatment of it, if elevated, are important during the first few days after thrombolysis. High systolic BP both before and after thrombolysis was associated with poor outcome. This finding may support the practice of reducing systolic BP below 185 mm Hg both before and after thrombolysis.
体温、血糖和血压（BP）可能会干扰接受溶栓治疗的急性缺血性脑卒中患者的预后。
我们前瞻性地研究了挪威卑尔根127例接受组织纤溶酶原激活剂溶栓治疗急性脑卒中的患者。在溶栓前测量体温、血糖和血压。测量溶栓后前5天内的最高体温和最高血糖以及溶栓后前24小时内的最高血压。在卒中发作后3个月用改良Rankin量表评分评估预后。在调整溶栓前美国国立卫生研究院卒中量表评分和潜在混杂因素后，使用多因素逻辑回归分析对变量进行检验。
患者的平均年龄为63岁，美国国立卫生研究院卒中量表评分中位数为13分。入院时，6%的患者患有糖尿病，51%的患者患有高血压。溶栓后体温升高和血糖升高与预后不良相关（比值比[OR]2.84，95%置信区间[CI]1.29 - 6.25，P = 0.01；OR 1.33，95% CI 1.02 - 1.74，P = 0.03）。溶栓前体温升高和血糖升高与预后无关（OR 0.79，95% CI 0.39 - 1.58，P = 0.5；OR 1.04，95% CI 0.75 - 1.20，P = 0.08）。溶栓前后收缩压升高与预后不良相关（OR 1.27，95% CI 1.03 - 1.52，P = 0.025；OR 1.22，95% CI 1.00 - 1.44，P = 0.045）。溶栓前后舒张压升高与预后无关（OR 1.03，95% CI 0.97 - 1.36，P = 0.85；OR 1.16，95% CI 0.99 - 1.46，P = 0.29）。
本研究表明，在缺血性脑卒中患者中，溶栓后体温升高和血糖升高与预后不良相关。在溶栓后的头几天，频繁监测这些参数并对升高的情况进行适当治疗很重要。溶栓前后收缩压升高与预后不良相关。这一发现可能支持在溶栓前后将收缩压降至185 mmHg以下的做法。
