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目的:比较不同剂量乌拉地尔对急性缺血性脑卒中(AIS)患者降压效果和预后的影响,为其临床合理应用提供依据。方法:62例AIS患者随机分为高剂量组20例、中剂量组21例和低剂量组21例,均行乌拉地尔降压和尿激酶溶栓治疗,乌拉地尔首剂量分别为25,15,5 mg。观察患者入院至溶栓结束收缩压(SBP)与舒张压(DBP)变动水平;随访6~12个月,比较各组患者美国国立卫生院卒中量表(NIHSS)、改良Rankin量表(mRS)及日常生活能力量表(ADL)评分。结果:中剂量组和低剂量组血压达标时间均高于高剂量组,低剂量组血压达标时间高于中剂量组,差异均有统计学意义(P<0.05)。治疗后,各组患者溶栓前(T1)SBP与DBP水平显著低于治疗前(T_0),溶栓5 min(T_2)与溶栓结束时(T_3)时SBP与DBP水平显著低于T_1,差异有统计学意义(P<0.05);高剂量组患者T_1、T_2、T_3的SBP与DBP水平均低于中剂量组和低剂量组;中剂量组低于小剂量组,差异有统计学意义(P<0.05)。中剂量组NIHSS、mRS及ADL评分低于低剂量组和高剂量组(P<0.05),低剂量组和高剂量组之间差异无统计学意义(P>0.05)。结论:乌拉地尔首剂量为15 mg时,能够在有效降压的前提下保障较好的预后。
Objective: To compare the effects of different doses of urapidil on the antihypertensive efficacy and prognosis in patients with acute ischemic stroke (AIS), and to provide basis for their clinical application. Methods: Sixty-two patients with AIS were randomly divided into high dose group (20 cases), middle dose group (21 cases) and low dose group (21 cases). All the patients were treated with Urapidil and urokinase thrombolysis. The first dose of urapidil was 25, 15,5 mg. (SBP) and diastolic blood pressure (DBP) at the end of thrombolytic therapy were observed.All patients were followed up for NIHSS, mRS, And daily living ability scale (ADL) score. Results: The blood pressure of middle dose group and low dose group were higher than that of high dose group, while that of low dose group was higher than that of middle dose group. The difference was statistically significant (P <0.05). After treatment, the levels of SBP and DBP in patients before treatment (T1) were significantly lower than those before treatment (T_0), SBP and DBP levels at 5 min (T_2) and end of thrombolysis (T_3) (P <0.05). The levels of SBP and DBP in T 1, T 2 and T 3 in high dose group were lower than those in middle dose group and low dose group, and those in middle dose group were lower than those in low dose group (P <0.05). The scores of NIHSS, mRS and ADL in middle dose group were lower than those in low dose group and high dose group (P <0.05). There was no significant difference between low dose group and high dose group (P> 0.05). Conclusion: When the first dose of urapidil is 15 mg, better prognosis can be guaranteed under the premise of effective blood pressure lowering.