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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Effect of Pretreatment Blood Pressure on Outcomes in Thrombolysed Acute Ischemic Stroke Patients: A Systematic Review and Meta-analysis
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Effect of Pretreatment Blood Pressure on Outcomes in Thrombolysed Acute Ischemic Stroke Patients: A Systematic Review and Meta-analysis

机译：预处理血压对溶栓急性缺血性脑卒中患者结果的影响：系统综述与荟萃分析

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Background: Blood pressure (BP) is an important determinant of functional outcome in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (IV-tPA). Current guidelines recommend a BP target of 185/110 mmHg before IV-tPA bolus and maintaining it at less than 180/105 mmHg for the first 24 hours. However, the effect of blood pressure on various outcome measures after systemic thrombolysis remains unclear. Methods: Following a systematic search of Medline and EMBASE, all observational studies reporting effect of pretreatment BP on 90-day functional outcome as measured by the modified Rankin Scale (mRS) and/or incidence of symptomatic intracranial hemorrhage (sICH) in AIS patients receiving thrombolytic therapy were included. Results: Of 2181 studies screened, 26 studies, involving 38,937 subjects, met inclusion criteria. Higher prethrombolysis systolic BP was significantly-associated with poorer 90-day functional outcome (Mean difference 3.87 mmHg; 95% confidence interval [CI] 1.18-6.56) and increased incidence of sICH (Mean difference 5.31; 95% CI 2.22-8.40). When studies were stratified by different cut-offs for functional outcome (mRS 0-1 versus 0-2) and definitions of sICH used (Randomized controlled trials or SITS-MOST), there was no significant difference in mean difference between the subgroups. Conclusions: Our data showed that higher prethrombolysis SBP was associated with poorer outcomes in thrombolysed acute ischemic stroke patients. This may suggest that more aggressive lowering of BP below the current recommendations prior to thrombolysis could be beneficial. The effect of early BP trends after tPA infusion could not be evaluated due to limited available data. Ongoing randomized clinical trials, like ENCHANTED, may provide further insights into the current guidelines and optimal BP levels.
机译：背景：血压（BP）是用静脉内组织纤溶酶原激活剂（IV-TPA）处理的急性缺血性卒中（AIS）患者功能结果的重要决定因素。目前的指导方针建议在IV-TPA推注之前的185/110 mmHg的BP目标，并在前24小时保持少于180/105mmHg。然而，血压对全身溶栓后的各种结果措施的影响尚不清楚。方法：在系统搜索Medline and Embase，所有观察性研究报告预处理BP对90天功能结果的效果，如改性的Rankin规模（MRS）和/或症状颅内出血（SICH）接受的症状颅内出血（SICH）的发病率包括溶栓治疗。结果：2181项研究筛选，26项研究，涉及38,937名受试者，符合纳入标准。高血尿博博收缩型BP与较差的90天功能结果有显着相关（平均差异3.87mmHg; 95％置信区间[CI] 1.18-6.56）和SICH的发病率增加（平均差5.31; 95％CI 2.22-8.40）。当通过针对功能结果的不同切断（0-1夫人与0-2）的不同截止分层和使用的SICH的定义（随机对照试验或最多），亚组之间的平均差异没有显着差异。结论：我们的数据显示，血栓溶解急性缺血性卒中患者的较高的前胚栓塞SBP与较差的结果相关。这可能表明，在溶栓前的当前建议下方的BP更积极地降低BP可能是有益的。由于有限的可用数据，不能评估早期BP趋势在TPA输注后的影响。正在进行的随机临床试验，如被迷惑，可以进一步了解当前的指导和最佳BP水平。

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