Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China,
Cerebrovasc Dis. 2020;49(2):160-169. doi: 10.1159/000506855. Epub 2020 Apr 21.
This study aimed to control blood pressure (BP) under transcranial Doppler (TCD) guidance in patients with anterior circulation acute ischemic stroke after endovascular treatment (EVT) to reduce the incidence of early neurological deterioration (END) and improve neurological prognosis.
This prospective randomized controlled study included 95 patients who were randomly divided into a TCD-guided BP control (TBC) group and a non-TCD-guided BP control (NBC) group. The patients were monitored by TCD within 72 h after EVT. In the TBC group, BP decreased, BP increased, or intracranial pressure decreased when TCD showed blood flow acceleration, deceleration, or intracranial hypertension respectively. The BP of the NBC group was controlled according to the guidelines. The incidence of END and the prognosis was compared between the 2 groups.
TCD identified 18 patients with blood flow acceleration, but the prognosis of the 2 groups was not significantly different. TCD identified 23 patients with blood flow deceleration, and the poor prognosis rate at discharge was lower in the TBC group than in the NBC group (45.5 vs. 91.7%, p = 0.027). TCD identified 34 patients with intracranial hypertension, and the 3-month mortality rate of the TBC group was lower than that of the NBC group (0 vs. 36.8%, p = 0.011). The incidence rates of END and 3-month mortality in the TBC group were lower than those in the NBC group (13.8 vs. 37.5%, p = 0.036; 0 vs. 25.0%, p = 0.012) when TCD parameters were abnormal. Multivariable logistic regression analysis showed that the TBC group (adjusted OR 0.267, 95% CI 0.074-0.955; p = 0.042) was an independent protective factor against the incidence of END when TCD parameters were abnormal.
These findings indicated that TCD-guided BP and intracranial pressure control improved the prognosis of patients with blood flow deceleration and intracranial hypertension.
本研究旨在通过经颅多普勒（TCD）引导控制血管内治疗（EVT）后前循环急性缺血性卒中患者的血压，以降低早期神经功能恶化（END）的发生率并改善神经预后。
这是一项前瞻性随机对照研究，共纳入 95 例患者，随机分为 TCD 引导血压控制（TBC）组和非 TCD 引导血压控制（NBC）组。患者在 EVT 后 72 小时内通过 TCD 监测。在 TBC 组中，当 TCD 显示血流加速、减速或颅内压升高时，分别降低血压、升高血压或降低颅内压。NBC 组根据指南控制血压。比较两组患者 END 的发生率和预后。
TCD 识别出 18 例血流加速患者，但两组患者的预后无显著差异。TCD 识别出 23 例血流减速患者，TBC 组出院时预后不良的发生率低于 NBC 组（45.5% vs. 91.7%，p=0.027）。TCD 识别出 34 例颅内高压患者，TBC 组 3 个月死亡率低于 NBC 组（0% vs. 36.8%，p=0.011）。当 TCD 参数异常时，TBC 组 END 的发生率和 3 个月死亡率均低于 NBC 组（13.8% vs. 37.5%，p=0.036；0% vs. 25.0%，p=0.012）。多变量逻辑回归分析显示，当 TCD 参数异常时，TBC 组（校正 OR 0.267，95%CI 0.074-0.955；p=0.042）是 END 发生率的独立保护因素。
这些发现表明，TCD 引导的血压和颅内压控制改善了血流减速和颅内高压患者的预后。
