急性缺血性脑卒中和脑出血后血压变异性:定义、干预机会和研究方向

IF 3.6 3区 医学 Q2 CLINICAL NEUROLOGY
David Z Rose, Alejandro A Rabinstein, May Kim-Tenser, Sergio D Bergese, Gabriel V Fontaine, Charles Kircher, Adnan I Qureshi
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引用次数: 0

摘要

脑血管急症急性期血压变异性(BPV)升高,如急性缺血性卒中(AIS)和脑出血(ICH),已被证明会导致预后恶化。尽管有几项研究报道了这种关联,但对于具体的BPV目标或AIS或ICH中BPV的一致、统一定义尚未达成共识。因此,我们召集了脑血管急诊血压变异性协会,由卒中、神经危重症护理、围手术期医学、急诊医学和临床药学的多学科专家组成,以评估BPV的临床影响,并就BPV的定义、确定减轻BPV增加带来的负面结果的干预措施达成工作共识,并为未来的BPV研究概念奠定基础。首先,该协会提出将收缩期BPV (SBPV)分为两个不同的时期——sbpv1和SBPV2。SBPV1涉及超急性期管理,此时快速平稳的血压控制至关重要。SBPV2,稳定期,包括一个更渐进的,维持治疗的斜坡。在这两个阶段,实现“平稳”(SBPV1)和“持续”(SBPV2)轨迹可能是理想的,但需要更多的阶段特定研究来验证这一概念。其次,Consortia建议通过在随后的测量中减去最大和最小收缩压来计算BPV,因为它在许多文献中提出的方程中代表了最具临床可行性的选择。第三,对于脑出血,协会首选静脉降压药物,以尽可能快速、安全、有效地达到BPV目标,这与美国心脏协会/美国卒中协会指南推荐的“限制BPV并实现平稳、持续的血压控制的治疗方案”一致。对于AIS,指南尚未涉及BPV,但联盟成员提出了一种基于时间(作为卒中急性度的函数)、动脉亚型(大、中、小血管)、溶栓和/或取栓状态以及呈现收缩压的不同SBPV目标的算法。随着对BPV理解的发展,未来的研究可能会建立和/或完善该联盟提出的概念。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Blood Pressure Variability After Acute Ischemic Stroke and Intracerebral Hemorrhage: Refining Its Definition, Intervention Opportunities, and Research Directions.

Increased blood pressure variability (BPV) in the acute phases of cerebrovascular emergencies, such as acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH), has been shown to result in worsened outcomes. Although several studies have reported this association, no consensus exists for specific BPV targets or a consistent, unified definition of BPV in AIS or ICH. Therefore, we convened the Blood Pressure Variability in Cerebrovascular Emergencies Consortia, consisting of a multidisciplinary group of experts in stroke, neurocritical care, perioperative medicine, emergency medicine, and clinical pharmacy to assess the clinical impact of BPV and to develop a working consensus on defining BPV, identifying interventions to mitigate negative outcomes from increased BPV, and laying the groundwork for BPV research concepts in the future. First, the Consortia proposed bifurcating systolic BPV (SBPV) into two distinct periods-SBPV1 and SBPV2. SBPV1 involves hyperacute management, when rapid and smooth blood pressure control is crucial. SBPV2, the plateauing phase, consists of a more gradual, maintenance-therapy slope. For both periods, enabling a "smooth" (SBPV1) and "sustained" (SBPV2) trajectory is likely ideal, but more phase-specific research is required to validate this concept. Secondly, Consortia proposed to calculate BPV by subtracting maximum and minimum systolic blood pressure over subsequent measurements because it represents the most clinically feasible option among many proposed equations in the literature. Third, for ICH, the Consortia preferred intravenous antihypertensive medication to reach BPV goals as fast, safe, and efficiently as possible, consistent with American Heart Association/American Stroke Association guidelines recommending "treatment regimens that limit BPV and achieve smooth, sustained blood pressure control." For AIS, guidelines do not yet address BPV, but Consortia members proposed an algorithm with distinct SBPV goals based on time (as a function of stroke acuity), arterial subtype (large, medium, and small vessel), thrombolytic and/or thrombectomy status, and presenting SBP. As the understanding of BPV evolves, future research may build on and/or refine concepts proposed by this Consortia.

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来源期刊
Neurocritical Care
Neurocritical Care 医学-临床神经学
CiteScore
7.40
自引率
8.60%
发文量
221
审稿时长
4-8 weeks
期刊介绍: Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.
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