急性缺血性卒中超早期血压管理研究进展

doi:10.3969/j.issn.1673-5765.2025.07.005

中国卒中杂志 ›› 2025, Vol. 20 ›› Issue (7): 829-839.DOI: 10.3969/j.issn.1673-5765.2025.07.005

急性缺血性卒中超早期血压管理研究进展

杨志进¹，谭荃丹^2，3，毛凤凯^2，3，李朝晖¹，陈晨⁴，李刚^4，5，杨杰⁶，林亚鹏^2，3，7

1 达州 635100 大竹县人民医院神经内科
2 成都医学院临床医学院
3 成都医学院第一附属医院神经内科
4 同济大学附属东方医院神经内科
5 同济大学脑血管病研究中心
6 四川省医学科学院·四川省人民医院（电子科技大学附属医院）神经内科
7 大连医科大学研究生院

收稿日期:2025-03-30 修回日期:2025-06-05 接受日期:2025-06-12 出版日期:2025-07-20 发布日期:2025-07-20
通讯作者: 杨杰 yangjie1126@163.com 林亚鹏 linyapengsjnk@163.com
基金资助:
国家自然科学基金面上项目（82171295）
四川省科技计划项目重点研发计划（2023YFS0042）

Research Progress on Ultra-Early Blood Pressure Management in Acute Ischemic Stroke

YANG Zhijin¹, TAN Quandan^2,3, MAO Fengkai^2,3, LI Zhaohui¹, CHEN Chen⁴, LI Gang^4,5, YANG Jie⁶, LIN Yapeng^2,3,7

1 Department of Neurology, Dazhu County People’s Hospital, Dazhou 635100, China
2 School of Clinical Medicine, Chengdu Medical College, Chengdu 610500, China
3 Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China
4 Neurology Department, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200123, China
5 Institute of Cerebrovascular Disease, Tongji University, Shanghai 200123, China
6 Department of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
7 Graduate School, Dalian Medical University, Dalian 116044, China

Received:2025-03-30 Revised:2025-06-05 Accepted:2025-06-12 Online:2025-07-20 Published:2025-07-20
Contact: YANG Jie, E-mail: yangjie1126@163.com LIN Yapeng, E-mail: linyapengsjnk@163.com

摘要/Abstract

摘要： 卒中是全球范围内致残和致死的主要病因之一，其中缺血性卒中占卒中的70%以上，是全球重大公共卫生问题之一。急性缺血性卒中（acute ischemic stroke，AIS）患者发病早期常出现血压升高，大量观察性研究提示血压升高与AIS患者预后不良相关。AIS超早期血压管理的核心挑战在于脑血流自动调节受损背景下血压波动对缺血半暗带的双重影响，合理的血压管理策略是改善患者预后的关键因素之一。当前，在AIS超早期血压管理领域，在降压时机的抉择、目标血压值的个体化设定，以及不同降压策略对脑灌注和再灌注损伤的影响等方面仍存在广泛争议。鉴于此，本文对AIS超早期血压管理的最新研究进展进行梳理与探讨，以期为临床实践提供更具价值的参考。

文章导读： 目前急性缺血性卒中超早期血压管理存在争议，且缺少循证证据指导下的治疗策略，临床实践中应根据患者的疾病特点、治疗需求，在指南建议范围内进行个体化血压管理。

关键词: 急性缺血性卒中; 超早期; 血压管理; 缺血再灌注损伤

Abstract: Stroke is one of the leading causes of disability and death worldwide, with ischemic stroke accounting for over 70% of all stroke cases, making it a major global public health issue. Patients with acute ischemic stroke (AIS) often exhibit elevated blood pressure in the early phase after onset, and numerous observational studies suggest that elevated blood pressure is associated with poor prognosis. The core challenge in ultra-early blood pressure management for AIS lies in the dual-directional impact of blood pressure fluctuations on the ischemic penumbra against the backdrop of impaired cerebral autoregulation. A rational blood pressure management strategy is one of the key factors to improve patient outcomes. Currently, significant controversies persist regarding the timing of blood pressure lowering, individualized blood pressure target setting, and the effects of different antihypertensive strategies on cerebral perfusion and reperfusion injury in the ultra-early phase of AIS. Given this, this article reviews and discusses the latest research progress in ultra-early blood pressure management for AIS, aiming to provide more valuable references for clinical practice.

Key words: Acute ischemic stroke; Ultra-early phase; Blood pressure management; Ischemia reperfusion injury

中图分类号:

R74
R459.7

杨志进, 谭荃丹, 毛凤凯, 李朝晖, 陈晨, 李刚, 杨杰, 林亚鹏. 急性缺血性卒中超早期血压管理研究进展[J]. 中国卒中杂志, 2025, 20(7): 829-839.

YANG Zhijin, TAN Quandan, MAO Fengkai, LI Zhaohui, CHEN Chen, LI Gang, YANG Jie, LIN Yapeng. Research Progress on Ultra-Early Blood Pressure Management in Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2025, 20(7): 829-839.

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急性缺血性卒中超早期血压管理研究进展

Research Progress on Ultra-Early Blood Pressure Management in Acute Ischemic Stroke

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