大脑中动脉M1段急性闭塞机械取栓术中术后 血压参数与预后关系研究

Middle Cerebral Artery M Relationship between Postoperative Blood Pressure Parameters and Prognosis in Mechanical Thrombectomy of 1-Segment Acute Occlusion

摘要: 血管内治疗已成为急性大血管闭塞性缺血性脑卒中的标准治疗方案。尽管再通率显著提高，但仍有近半数患者预后不良，这促使研究者寻找影响预后的可干预因素。围手术期血压管理是其中最关键且最具争议的环节之一。本文旨在系统综述近年来关于取栓术后不同血压参数(包括血压平均水平、血压变异性、血压极端值及夜间血压模式)与患者神经功能预后、出血转化及死亡率之间关系的研究进展。现有证据表明，术后血压过高或过低均与不良预后相关，可能存在一个“U型”关系；此外，血压变异性很可能是独立于血压平均水平的强预测因子。然而，最佳血压目标值仍因患者个体特征(如再通程度、侧支循环、高血压病史)而异。本文总结了当前研究的共识、争议，并展望了未来个体化血压管理的研究方向。

Abstract: Endovascular treatment has become the standard treatment option for acute large vessel occlusive ischemic stroke. Although the recanalization rate has significantly increased, nearly half of the patients still have a poor prognosis, which prompts researchers to look for modifiable factors that affect prognosis. Perioperative blood pressure management is one of the most crucial and controversial links among them. This article aims to systematically review the research progress in recent years on the relationship between different blood pressure parameters (including average blood pressure level, blood pressure variability, extreme blood pressure values and nocturnal blood pressure patterns) after thrombectomy and the neurological prognosis, hemorrhagic transformation and mortality of patients. Existing evidence indicates that both excessively high and low postoperative blood pressure are associated with a poor prognosis, and there may be a “U-shaped” relationship. Furthermore, blood pressure variability is likely to be a strong predictor independent of the average blood pressure level. However, the optimal blood pressure target value still varies depending on the individual characteristics of the patient, such as the degree of recanalization, collateral circulation, and history of hypertension. This article summarizes the current research consensus and controversies, and looks forward to the future research directions of individualized blood pressure management.