Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea.
J Neurol Sci. 2011 Sep 15;308(1-2):72-6. doi: 10.1016/j.jns.2011.06.009. Epub 2011 Jun 25.
Although an early neurological deterioration after lacunar infarction is not rare, its therapeutic options are still undetermined. We investigated the effect of induced-hypertension in lacunar infarction with motor progression.
We reviewed 82 lacunar infarction patients who experienced motor progression [≥ 1-point increase of NIH stroke scale (NIHSS) during hospitalization]. Induced-hypertension using phenylephrine was applied to 52 patients and the others received conventional treatment. Target blood pressure (BP) was defined as a 20% increase of initial systolic BP and motor stabilization time as a period from motor progression to motor stabilization. Good outcome was designated as a modified Rankin disability scale 0-2 at discharge in phenylephrine group.
Phenylephrine group (vs. conventional group) had a lower NIHSS motor score after each treatment (p=0.022), a shorter motor stabilization time (p<0.001) and hospitalization period (p=0.047), although there were not significantly different from baseline clinical and laboratory findings (ie. age, sex, risk factors for stroke, initial BPs, and NIHSS motor score) in two groups. In multiple regression analysis, a history of hypertension (odds ratio, OR 7.11, 95% CI 1.43-35.31, p=0.016), achievement of target BP (OR 8.13, 95% CI 1.49-44.45, p=0.016) and motor stabilization time (OR 0.51 per 1-day increase, 95% CI 0.29-0.87, p=0.015) were independent predictors for good outcome in the phenyephrine group. Side effects of phenylephrine treatment were transient chest tightness (n=3) and dysuria (n=2).
The present study suggests that phenylephrine induced-hypertension can result in early motor restoration without serious side effects in progressing lacunar infarction.
尽管腔隙性梗死后早期神经功能恶化并不罕见，但治疗选择仍不确定。我们研究了诱导高血压对进展性腔隙性梗死的影响。
我们回顾了 82 例发生运动进展的腔隙性梗死患者[住院期间 NIH 卒中量表（NIHSS）增加≥1 分]。52 例患者接受苯肾上腺素诱导高血压治疗，其余患者接受常规治疗。目标血压（BP）定义为初始收缩压增加 20%，运动稳定时间为运动进展至运动稳定的时间段。苯肾上腺素组出院时改良 Rankin 残疾量表评分为 0-2 分定义为良好结局。
与常规组相比，苯肾上腺素组在每次治疗后 NIHSS 运动评分均较低（p=0.022），运动稳定时间较短（p<0.001）和住院时间较短（p=0.047），尽管两组之间的基线临床和实验室发现（即年龄、性别、卒中危险因素、初始 BP 和 NIHSS 运动评分）无显著差异。多因素回归分析显示，高血压病史（比值比，OR 7.11，95%可信区间 1.43-35.31，p=0.016）、达到目标 BP（OR 8.13，95%可信区间 1.49-44.45，p=0.016）和运动稳定时间（OR 每增加 1 天 0.51，95%可信区间 0.29-0.87，p=0.015）是苯肾上腺素组良好结局的独立预测因素。苯肾上腺素治疗的副作用为短暂性胸闷（n=3）和排尿困难（n=2）。
本研究表明，苯肾上腺素诱导高血压可导致进展性腔隙性梗死早期运动恢复，无严重副作用。
