Stroke:血压变异性、心率变异性和压力反射敏感性对卒中结局的预测

2020-01-24 xing.T MedSci原创

除了已知的预后因素(例如美国国立卫生研究院卒中量表)外,收缩压BPV的低频/高频比率降低和压力反射敏感性降低也预示了不良的卒中预后。

卒中后自主神经功能障碍预后不良。近日,心血管疾病领域权威杂志Stroke上发表了一篇研究文章,研究人员旨在调查了血压变异性(BPV)、心率变异性和压力反射敏感性是否可以预测卒中患者功能预后。

研究人员从卒中发作后7天内的5分钟血压和心率监测中计算了BPV、心率变异性、压力反射斜率和压力反射有效性指数,并比较了具有良好结局(改良Rankin量表评分为0–2)和结局较差患者之间的参数。

在142例患者中(平均年龄为63.9±10.2岁;男性为88.0%),功能预后良好的患者有112例(78.9%),较差的患者有30例(21.1%)。两组患者的入院美国国立卫生研究院卒中量表评分、既往卒中、高频收缩压BPV、BPV低频/高频比率、压力反射敏感性上升和压力反射敏感性总和之间存在显著差异(所有P<0.05)。在多变量分析中,美国国立卫生研究院卒中量表(OR为1.672 [95%CI为1.316–2.125]; P<0.001)、收缩压BPV的低频/高频比(OR为0.493 [95%CI为0.250-0.973];P=0.041)和压力反射效率指数降低(OR为0.958 [95%CI为0.924-0.992]; P=0.017)可独立地预测功能不良结局。

除了已知的预后因素(例如美国国立卫生研究院卒中量表)外,收缩压BPV的低频/高频比率降低和压力反射敏感性降低也预示了不良的卒中预后。

原始出处:

Shujin Tang.et al.Stroke Outcome Prediction by Blood Pressure Variability, Heart Rate Variability, and Baroreflex Sensitivity.stroke.2020.https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.027981

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    2020-01-25 一天没事干

    很好的学习机会

    0

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    2020-01-24 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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    2020-01-24 心介

    #血压变异性#相信未来5年是热点,不仅关心血压高与低,还要关注血压变异性才可以

    0

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Diabetes Obes Metab:2型糖尿病患者血压变异性、心血管疾病和死亡率之间的关联

由此可见,该研究结果表明相比于与平均血压,BPV对2型糖尿病患者CVD风险的影响可能提供了额外的信息。

Hypertension:血压变异性增大提示阿尔茨海默病认知恶化

血压变异性(BPV)比单纯的血压(BP)更有卒中预测价值。近期发表于Hypertension杂志的一项研究对BPV的具体预测价值进行了评估。研究人员以一项欧洲多中心、双盲、安慰剂对照轻中度阿尔茨海默病治疗III期试验的数据为基础,评估BPV是否能预测阿尔茨海默病所致认知功能下降。研究纳入诊室血压测量3次以上可用于确定BPV轻度至中度阿尔茨海默新疆人民核心技术美患者,并使用亚组样本中的家庭血压测量值

Stroke:既往卒中患者血压变异性与心血管结局

由此可见,该研究表明BPV是缺血性卒中、心血管事件和全因死亡的重要且可能可改变的风险因素。具体而言,这是第一项证明BPV增加与复发性缺血性卒中相关的研究,舒张压BPV与收缩期BPV同样重要。未来的工作应该集中在评估是否积极降低BPV,使用广泛可用且廉价的抗高血压药物,以降低心血管疾病的风险。

Stroke:血管内血栓切除术后的血压变异性与神经功能结局

由此可见,在接受EVT治疗的卒中患者中,发病24小时内较高的BPV与90天预后较差有关。这种关联对于收缩期BPV更稳健。BPV可能对神经系统结局产生负面影响的机制仍未明确,但是这种关联的一致性值得进一步研究。