《急性缺血性脑血管病血压管理指南概要课件》由会员分享，可在线阅读，更多相关《急性缺血性脑血管病血压管理指南概要课件（13页珍藏版）》请在金锄头文库上搜索。
1、,Recommendations2. Patients who have elevated blood pressure and are otherwise eligible for treatment with intravenous rtPA should have their blood pressure carefully lowered(Table 9) so that their systolic blood pressureis 185 mm Hg and their diastolic blood pressure is185/110 mm Hg:Labetalol 1020
2、mg IV over 12 minutes, may repeat 1 time; orNicardipine 5 mg/h IV, titrate up by 2.5 mg/h every 515 minutes, maximum 5 mg/h; when desired BP reached, adjust to maintain proper BP limits; orOther agents (hydralazine, enalaprilat, etc) may be considered when appropriateIf BP is not maintained at or be
3、low 185/110 mm Hg, do not administer rtPA Management of BP during and after rtPA or other acute reperfusion therapy to maintain BP at or below 180/105 mm Hg:Monitor BP every 15 minutes for 2 hours from the start of rtPA therapy, then every 30 minutes for 6 hours, and then every hour for 16 hoursIf s
4、ystolic BP 180230 mm Hg or diastolic BP 105120 mm Hg:Labetalol 10 mg IV followed by continuous IV infusion 28 mg/min; orNicardipine 5 mg/h IV, titrate up to desired effect by 2.5 mg/h every 515minutes, maximum 15 mg/h If BP not controlled or diastolic BP 140 mm Hg, consider IV sodium nitroprusside,7
5、. In patients with markedly elevated blood pressure who do not receive fibrinolysis, a reasonable goal is to lower blood pressure by 15% during the first 24 hours after onset of stroke. The level of blood pressure that would mandate such treatment is not known, but consensus exists that medications
6、should be withheld unless the systolic blood pressure is 220mm Hg or the diastolic blood pressure is 120 mm Hg (Class I; Level of Evidence C). (Revised from the previous guideline13),10. Evidence from one clinical trial indicates that initiation of antihypertensive therapy within 24 hours of stroke
7、is relatively safe. Restarting antihypertensive medications is reasonable after the first 24 hours for patients who have preexisting hypertension and are neurologically stable unless a specific contraindication to restarting treatment is known (Class IIa; Level of Evidence B). (Revised from the prev
8、ious guideline13),11. No data are available to guide selection of medications for the lowering of blood pressure in the setting of acute ischemic stroke. The antihypertensive medications and doses included in Table 9 are reasonable choices based on general consensus (Class IIa; Level of Evidence C).
9、 (Revised from the previous guideline13),13. The management of arterial hypertension in patients not undergoing reperfusion strategies remains challenging.Data to guide recommendations for treatment are inconclusive(不确定的) or conflicting（冲突的）. Many patients have spontaneous declines in blood pressure
10、 during the first 24 hours after onset of stroke. Until more definitive data are available, the benefit of treating arterial hypertension in the setting of acute ischemic stroke is not well established (Class IIb; Level of Evidence C). Patients who have malignant hypertension or other medical indica
11、tions for aggressive treatment of blood pressure should be treated accordingly.(Revised from the previous guideline13),中国脑血管病防治指南,脑血管病患者多伴血压升高。由于合并高血压的机制及相关因素比较复杂，在处理高血压时，难以有一个统一的方案，必须进行个体化治疗，才能达到较理想的血压水平，有利于脑血管病的总体治疗和康复。,脑血管病合并高血压的处理原则有： （1）积极平稳控制过高的血压。 （2）防止降血压过低、过快。 （3）严密监测血压变化，尤其在降血压治疗过程中。 （4）降血
12、压宜缓慢进行，因为此类患者的血压自动调节功能差，急速大幅降血压则易导致脑缺血。 （5）降血压要个体化治疗，因为每个患者的基础血压不同，对原有降血压药物敏感性不同，以及合并其他不同的疾病等。 （6）维持降血压效果的平稳性，一般主张采用长效降血压药物。 （7）在降血压过程中应注意靶器官的保护，尤其是脑、心、肾。,不同情况的脑梗死，其高血压的处理不同。如果需要降血压治疗，建议首选静脉用药，最好应用微量输液泵。在应用降血压药过程中，避免血压降得过低，加重脑梗死。,1、早期脑梗死：许多脑梗死患者在发病早期，其血压均有不高程度的升高，且其升高的程度与脑梗死病灶大小、部位及病前是否患有高血压病有关。脑梗死早
13、期的高血压处理取决于血压升高的程度及患者的整体情况和基础血压来定。如收缩压在185210mmHg或舒张压在115120mmHg之间，也可不必急于降血压治疗，但应严密观察血压变化；如果220/120mmHg，则应给予缓慢降血压治疗，并严密观察血压变化，尤其防止血压降得过低。,2、出血性脑梗死：多见于脑栓塞、大面积脑梗死和溶栓治疗后。一旦发生出血脑梗死，应使收缩压180mmHg或舒张压105mmHg。 3、溶栓治疗前后：在溶栓治疗前后，如果收缩压180mmHg或舒张压105mmHg，则应及时降血压治疗，以防止发生继发性出血。最好使用微输液泵静注硝普钠，其能随时、迅速、平稳地降低血压至所需水平，具体用法为13g/kg/min。也可用利息定（压宁定）、卡维地洛、硝酸甘油等。,4、脑梗死恢复期：脑梗死进入恢复期后，均按高血压病的常规治疗要求，口服病前所用的降血压药或重新调整降血压药物，使血压缓慢平稳下降，一般应使血压控制在正常范围以内或可耐受的水平，以尽可能预防脑梗死复发。,
