血压管理对急性缺血性脑卒中血管内治疗神经功能结局的影响。
The influence of blood pressure management on neurological outcome in endovascular therapy for acute ischaemic stroke.
机构信息
Department of Anaesthesia and Intensive Care, Section of Neuroanaesthesia, Aarhus University Hospital, Denmark.
Department of Anaesthesia and Intensive Care, Section of Neuroanaesthesia, Aarhus University Hospital, Denmark.
出版信息
Br J Anaesth. 2018 Jun;120(6):1287-1294. doi: 10.1016/j.bja.2018.01.039. Epub 2018 Mar 28.
BACKGROUND
Observational studies have suggested that low blood pressure and blood pressure variability may partially explain adverse neurological outcome after endovascular therapy with general anaesthesia (GA) for acute ischaemic stroke. The aim of this study was to further examine whether blood pressure related parameters during endovascular therapy are associated with neurological outcome.
METHODS
The GOLIATH trial randomised 128 patients to either GA or conscious sedation for endovascular therapy in acute ischaemic stroke. The primary outcome was 90 day modified Rankin Score. The haemodynamic protocol aimed at keeping the systolic blood pressure >140 mm Hg and mean blood pressure >70 mm Hg during the procedure. Blood pressure related parameters of interest included 20% reduction in mean blood pressure; mean blood pressure <70 mm Hg, <80 mm Hg, and <90 mm Hg, respectively; time with systolic blood pressure <140 mm Hg; procedural minimum and maximum mean and systolic blood pressure; mean blood pressure at the time of groin puncture; postreperfusion mean blood pressure; blood pressure variability; and use of vasopressors. Sensitivity analyses were performed in the subgroup of reperfused patients.
RESULTS
Procedural average mean and systolic blood pressures were higher in the conscious sedation group (P<0.001). The number of patients with mean blood pressure <70-90 mm Hg and systolic blood pressure <140 mm Hg, blood pressure variability, and use of vasopressors were all higher in the GA group (P<0.001). There was no statistically significant association between any of the examined blood pressure related parameters and the modified Rankin Score in the overall patient population, and in the subgroup of patients with full reperfusion.
CONCLUSION
We found no statistically significant association between blood pressure related parameters during endovascular therapy and neurological outcome.
CLINICAL TRIAL REGISTRATION
NCT 02317237.
背景
观察性研究表明，在全身麻醉（GA）下进行血管内治疗急性缺血性卒中后，低血压和血压变异性可能部分解释了不良的神经结局。本研究旨在进一步探讨血管内治疗过程中的血压相关参数是否与神经结局相关。
方法
GOLIATH 试验将 128 例患者随机分为 GA 组或清醒镇静组进行急性缺血性卒中的血管内治疗。主要结局是 90 天改良 Rankin 评分。血流动力学方案的目的是在手术过程中保持收缩压>140mmHg 和平均血压>70mmHg。感兴趣的血压相关参数包括平均血压下降 20%；平均血压分别<70mmHg、<80mmHg 和<90mmHg；收缩压<140mmHg 的时间；手术过程中最低和最高平均及收缩压；股动脉穿刺时的平均血压；再灌注后的平均血压；血压变异性；和血管加压药的使用。在再灌注患者亚组中进行了敏感性分析。
结果
清醒镇静组术中平均血压和收缩压较高（P<0.001）。平均血压<70-90mmHg 和收缩压<140mmHg、血压变异性和血管加压药使用的患者数量在 GA 组更高（P<0.001）。在总体患者人群中，以及在完全再灌注的患者亚组中，检查的血压相关参数与改良 Rankin 评分之间均无统计学显著相关性。
结论
我们没有发现血管内治疗过程中的血压相关参数与神经结局之间存在统计学显著关联。
临床试验注册
NCT 02317237。
Zotero 插件