急性缺血性脑血管病血压管理指南.ppt

Recommendations 2. 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 is110 mm Hg (Class I; Level of Evidence B) before fibrinolytic therapy is initiated. If medications are given to lower blood pressure, the clinician should be sure that the blood pressure is stabilized at the lower level before beginning treatment with intravenous rtPA and maintained below 180/105 mm Hg for at least the first 24 hours after intravenous rtPA treatment. (Unchanged from the previous guideline13) Table 9. Potential Approaches to Arterial Hypertension in Acute Ischemic Stroke Patients Who Are Candidates for AcuteReperfusion Therapy Patient otherwise eligible for acute reperfusion therapy except that BP is185/110 mm Hg: Labetalol 10–20 mg IV over 1–2 minutes, may repeat 1 time; or Nicardipine 5 mg/h IV, titrate up by 2.5 mg/h every 5–15 minutes, maximum 5 mg/h; when desired BP reached, adjust to maintain proper BP limits; or Other agents (hydralazine, enalaprilat, etc) may be considered when appropriate If BP is not maintained at or below 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 hours If systolic BP 180–230 mm Hg or diastolic BP 105–120 mm Hg: Labetalol 10 mg IV followed by continuous IV infusion 2–8 mg/min; or Nicardipine 5 mg/h IV, titrate up to desired effect by 2.5 mg/h every 5–15minutes, maximum 15 mg/h If BP not controlled or diastolic BP 140 mm Hg, consider IV sodium nitroprusside 7. In patients with markedly elevated blood pressure who do not receive fibrinolysis, a reasona