Stroke:急性卒中后 服用硝酸甘油获益大吗?

2019-02-13 王淳 环球医学

2019年1月,发表于《Stroke》上的一项研究,考察了硝酸甘油(GTN)对急性卒中血流动力学的影响。

2019年1月,发表于《Stroke》上的一项研究,考察了硝酸甘油(GTN)对急性卒中血流动力学的影响。

背景和目的:血压、心率及其相关指标(变异度、脉压、心率-收缩压乘积)升高与急性卒中患者较差的临床结局相关。研究者评估了ENOS试验(一氧化氮治疗卒中的有效性)的参与者中,GTN对血流动力学参数和结局的影响。

方法:4011名急性卒中和血压升高的患者在症状发作的48小时内随机分配到经皮GTN组或不进行GTN组中,共治疗7天。在基线(3次)和治疗期间每天(2次)测量了外周血流动力学数据。按五分位数评估了第1~7天每次就诊间的血压变异性(表示为SD)。通过改良Rankin量表评估了功能结局,通过电话微型精神状态检查评估了90天时的认知功能。分析调整了基线预后变量。效应值数据为均差或比值比及其95%置信区间。

结果:基线血压(舒张压,变异性)、心率和心率-收缩压乘积增加都与90天时的不良功能结局相关。就诊期间收缩压变异性的增加与较差的改良Rankin量表评价(最高五分位数的调整OR,1.65;95% CI,1.37~1.99)、较差的认知功能评分(电话微型精神状态检查:最高五分位数的调整均差,-2.03;95% CI,-2.84~-1.22)和90天时死亡几率的增加(最高五分位数的调整OR,1.57;1.12~2.19)相关。GTN可降低血压和心率-收缩压乘积,增加治疗第一天时的心率,并可降低就诊期间的收缩压变异性。

结论:急性卒中后,两次就诊期间的血压变异性增加与较差的功能和认知结局相关,并增加90天死亡率。除了降压和降低心率-血压乘积外,GTN可降低就诊期间的收缩压变异性。降低急性卒中患者血压变异性的药物需要进一步研究。

原始出处:

Appleton JP, Woodhouse LJ, Bereczki D, et.al. Effect of Glyceryl Trinitrate on Hemodynamics in Acute Stroke. Stroke. 2019 Feb;50(2):405-412. doi: 10.1161/STROKEAHA.118.023190.

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    2019-02-13 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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