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Stroke：三硝酸甘油酯对急性脑卒中患者血流动力学的影响

2019-01-11 xing.T MedSci原创

三硝酸甘油酯急性脑卒中血流动力学影响
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由此可见，随访时血压变异性增加与急性卒中后较差的功能和认知结局以及90天死亡率增加有关。除降低血压和心率-收缩压乘积外，GTN还降低了访视期间收缩压的变异性。但降低急性卒中血压变异性的药物需要进一步研究。

血压（BP）、心率及其衍生物（变异性、脉压、心率-收缩压乘积）的增加与急性卒中患者的不良临床结局相关。近日，心血管疾病领域权威杂志Stroke上发表了一篇研究文章，研究人员评估了三硝酸甘油酯（GTN）对血液动力学参数的影响以及对ENOS试验参与者（一氧化氮对卒中疗效）结局的影响。

4011名急性卒中和血压升高的患者在发病后48小时内被随机分配至透皮GTN或无GTN治疗7天。在治疗期间的基线（3次测量）和每天（2次测量）测量外周血流动力学。研究人员评估了第1天至第7天之间的血压变异性（表示为SD）。在第90天，将功能结局评估为改良的Rankin量表和认知作为电话迷你精神状态检查。对基线预后变量调整后进行分析。数据以平均差异或优势比以及95％CI来表示。

增加的基线血压（舒张压，变异性）、心率和心率-收缩压乘积的增加均与第90天的不良功能结局相关。访视时收缩压的变异性增加与改良Rankin量表的不利变化（最高五分位数调整后的比值比为1.65; 95％CI为1.37-1.99）、较差的认知评分（电话迷你精神状态检查：最高五分位数调整后的平均差异为-2.03; 95％CI为-2.84至-1.22）以及第90天死亡几率增加（最高五分位调整后比值比为1.57; 95％CI为1.12-2.19）相关。GTN在第1天降低血压和心率-收缩压乘积并增加心率，以及减少访视期间收缩压的变异性。

由此可见，随访时血压变异性增加与急性卒中后较差的功能和认知结局以及90天死亡率增加有关。除降低血压和心率-收缩压乘积外，GTN还降低了访视期间收缩压的变异性。但降低急性卒中血压变异性的药物需要进一步研究。

原始出处：

Suzanne M. Silvi.et al.Effect of Glyceryl Trinitrate on Hemodynamics in Acute Stroke Data From the ENOS Trial.Stroke.2018.https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023190

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    2019-09-15 仁心济世

    #血流动力#

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    2019-07-28 weihongyv

    #脑卒中患者#

    0

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    2019-05-28 wangyang7969

    #卒中患者#

    0

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    2019-01-13 hb2008ye

    #硝酸甘油#

    0

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    2019-01-13 songbq

    #急性脑卒中#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1812071, encodeId=329d18120e163, content=<a href='/topic/show?id=d7a1891613d' target=_blank style='color:#2F92EE;'>#血流动力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89161, encryptionId=d7a1891613d, topicName=血流动力)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Sun Sep 15 11:13:00 CST 2019, time=2019-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1679124, encodeId=14b416e9124fc, content=<a href='/topic/show?id=7a2684e600b' target=_blank style='color:#2F92EE;'>#脑卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84760, encryptionId=7a2684e600b, topicName=脑卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=091e27733095, createdName=weihongyv, createdTime=Sun Jul 28 10:13:00 CST 2019, time=2019-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720274, encodeId=3f011e20274c5, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Tue May 28 20:13:00 CST 2019, time=2019-05-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1309338, encodeId=d69e13093382d, content=<a href='/topic/show?id=9faae35400d' target=_blank style='color:#2F92EE;'>#硝酸甘油#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73540, encryptionId=9faae35400d, topicName=硝酸甘油)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Sun Jan 13 04:13:00 CST 2019, time=2019-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366960, encodeId=901b136696096, content=<a href='/topic/show?id=d0e0524218b' target=_blank style='color:#2F92EE;'>#急性脑卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52421, encryptionId=d0e0524218b, topicName=急性脑卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=856b247, createdName=songbq, createdTime=Sun Jan 13 04:13:00 CST 2019, time=2019-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1392021, encodeId=8adc1392021b9, content=<a href='/topic/show?id=3704891621c' target=_blank style='color:#2F92EE;'>#血流动力学#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89162, encryptionId=3704891621c, topicName=血流动力学)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=99cf2500102, createdName=zjshifan_98647306, createdTime=Sun Jan 13 04:13:00 CST 2019, time=2019-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026260, encodeId=3dd910262606d, content=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！, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Jan 11 16:13:00 CST 2019, time=2019-01-11, status=1, ipAttribution=)]
    2019-01-13 zjshifan_98647306

    #血流动力学#

    0

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    2019-01-11 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