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长期以来,关于急性脑卒中患者的血压是保持在高水平还是降至较低水平的问题一直存在争议。目前已有部分较大的循证医学证据支持脑卒中急性期降压治疗的获益,提示在急性缺血性或出血性卒中患者中积极降低血压是安全和有效的。但是,在那些重度急性脑卒中、颅内血流动力学不稳定患者中的降压仍需慎重,尚需大规模临床研究结果进一步证实。应在实际工作中根据患者的个体情况、综合分析降压过程的利弊。目前国内比较公认的意见是:血压>200/130 mmHg时开始降压治疗,24 h血压下降应<25%;溶栓前、溶栓后24 h内控制血压<185/110 mmHg。
The question of whether blood pressure in acute stroke patients remain at high or low levels has long been controversial. There has been some larger evidence-based evidence that supports the benefit of antihypertensive treatment in acute stroke, suggesting that it is safe and effective to reduce blood pressure actively in patients with acute ischemic or hemorrhagic stroke. However, in those with severe acute stroke, intracranial hemodynamic instability in patients with antihypertensive still need to be cautious, still need to confirm the results of large-scale clinical studies. Should be based on the actual situation of patients in the actual work, a comprehensive analysis of the advantages and disadvantages of step-down process. At present, the more commonly accepted opinion is: blood pressure> 200/130 mmHg start antihypertensive treatment, 24 h blood pressure decline should be <25%; thrombolytic therapy, within 24 h after thrombolysis control blood pressure <185/110 mmHg.