Vitt Jeffrey R, Trillanes Michael, Hemphill J Claude
Department of Neurology, University of California, San Francisco, San Francisco, CA, United States.
Department of Pharmaceutical Services, University of California, San Francisco, San Francisco, CA, United States.
Front Neurol. 2019 Feb 21;10:138. doi: 10.3389/fneur.2019.00138. eCollection 2019.
Ischemic stroke is a common neurologic condition and can lead to significant long term disability and death. Observational studies have demonstrated worse outcomes in patients presenting with the extremes of blood pressure as well as with hemodynamic variability. Despite these associations, optimal hemodynamic management in the immediate period of ischemic stroke remains an unresolved issue, particularly in the modern era of revascularization therapies. While guidelines exist for BP thresholds during and after thrombolytic therapy, there is substantially less data to guide management during mechanical thrombectomy. Ideal blood pressure targets after attempted recanalization depend both on the degree of reperfusion achieved as well as the extent of infarction present. Following complete reperfusion, lower blood pressure targets may be warranted to prevent reperfusion injury and promote penumbra recovery however prospective clinical trials addressing this issue are warranted.
缺血性中风是一种常见的神经系统疾病，可导致严重的长期残疾和死亡。观察性研究表明，血压极高或极低以及血流动力学波动的患者预后较差。尽管存在这些关联，但缺血性中风急性期的最佳血流动力学管理仍是一个未解决的问题，尤其是在现代血管再通治疗时代。虽然有关于溶栓治疗期间及之后血压阈值的指南，但指导机械取栓期间管理的数据要少得多。尝试再通后的理想血压目标既取决于实现的再灌注程度，也取决于梗死范围。完全再灌注后，可能需要较低的血压目标以预防再灌注损伤并促进半暗带恢复，然而，有必要进行针对这一问题的前瞻性临床试验。
