急性期虚血性脳梗塞患者における初回端座位時の血圧変動と神経症状増悪との関連

【目的】急性期虚血性脳梗塞患者において初回の背臥位から端座位への姿勢変換による血圧変動とその後の神経症状増悪との関連を検討することを目的とした。【方法】発症24 時間以内に入院した虚血性脳梗塞患者165 名を対象に初回離床時に端座位を10 分間以上行い，背臥位と比較して端座位3 分後または10 分後の血圧変動の有無を評価した。対象者を入院7 日以内にNIHSS 値で2 点以上増加を認めた神経症状増悪群と非増悪群の2 群に分け， 調査項目や生化学的項目，血圧関連指標と神経症状増悪との関連を多重ロジスティック回帰分析を用いて検討した。【結果】増悪群は25 名（15.2％）であった。神経症状増悪の独...

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Published in理学療法学 Vol. 47; no. 6; pp. 523 - 530
Main Authors 谷﨑, 太朗, 中島, 宏樹, 神田, 敦子, 宮崎, 雄樹, 祖父江, 紗也花, 伊藤, 将平, 芹澤, 充洋
Format Journal Article
LanguageJapanese
Published 日本理学療法士学会 2020
日本理学療法士協会
Subjects
神経症状増悪
脳梗塞
血圧変動
Online AccessGet full text
ISSN0289-3770
2189-602X
DOI10.15063/rigaku.11787

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Abstract 【目的】急性期虚血性脳梗塞患者において初回の背臥位から端座位への姿勢変換による血圧変動とその後の神経症状増悪との関連を検討することを目的とした。【方法】発症24 時間以内に入院した虚血性脳梗塞患者165 名を対象に初回離床時に端座位を10 分間以上行い，背臥位と比較して端座位3 分後または10 分後の血圧変動の有無を評価した。対象者を入院7 日以内にNIHSS 値で2 点以上増加を認めた神経症状増悪群と非増悪群の2 群に分け， 調査項目や生化学的項目，血圧関連指標と神経症状増悪との関連を多重ロジスティック回帰分析を用いて検討した。【結果】増悪群は25 名（15.2％）であった。神経症状増悪の独立した関連因子として，穿通枝領域の脳梗塞，HDL コレステロール値，端座位時の血圧低下が抽出された。【結論】急性期虚血性脳梗塞患者において発症後早期の初回端座位時の血圧低下は入院7 日以内の神経症状増悪と関連することが示唆された。
AbstractList 【目的】急性期虚血性脳梗塞患者において初回の背臥位から端座位への姿勢変換による血圧変動とその後の神経症状増悪との関連を検討することを目的とした。【方法】発症24 時間以内に入院した虚血性脳梗塞患者165 名を対象に初回離床時に端座位を10 分間以上行い，背臥位と比較して端座位3 分後または10 分後の血圧変動の有無を評価した。対象者を入院7 日以内にNIHSS 値で2 点以上増加を認めた神経症状増悪群と非増悪群の2 群に分け， 調査項目や生化学的項目，血圧関連指標と神経症状増悪との関連を多重ロジスティック回帰分析を用いて検討した。【結果】増悪群は25 名（15.2％）であった。神経症状増悪の独立した関連因子として，穿通枝領域の脳梗塞，HDL コレステロール値，端座位時の血圧低下が抽出された。【結論】急性期虚血性脳梗塞患者において発症後早期の初回端座位時の血圧低下は入院7 日以内の神経症状増悪と関連することが示唆された。
「要旨」【目的】急性期虚血性脳梗塞患者において初回の背臥位から端座位への姿勢変換による血圧変動とその後の神経症状増悪との関連を検討することを目的とした. 【方法】発症24時間以内に入院した虚血性脳梗塞患者165名を対象に初回離床時に端座位を10分間以上行い, 背臥位と比較して端座位3分後または10分後の血圧変動の有無を評価した. 対象者を入院7日以内にNIHSS値で2点以上増加を認めた神経症状増悪群と非増悪群の2群に分け, 調査項目や生化学的項目, 血圧関連指標と神経症状増悪との関連を多重ロジスティック回帰分析を用いて検討した. 【結果】増悪群は25名(15.2%)であった. 神経症状増悪の独立した関連因子として, 穿通枝領域の脳梗塞, HDLコレステロール値, 端座位時の血圧低下が抽出された. 【結論】急性期虚血性脳梗塞患者において発症後早期の初回端座位時の血圧低下は入院7日以内の神経症状増悪と関連することが示唆された.
Author 中島, 宏樹
祖父江, 紗也花
伊藤, 将平
宮崎, 雄樹
芹澤, 充洋
神田, 敦子
谷﨑, 太朗
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一宮市立市民病院リハビリテーション室
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References 20) Kim YD, Choi HY, et al.: The Ischemic Stroke Predictive Risk Score Predicts Early Neurological Deterioration. J Stroke Cerebrovasc Dis. 2016; 25(4): 819–824.
23) Choi KH, Park MS, et al.: Serum triglyceride level is an important predictor of early prognosis in patients with acute ischemic stroke. J Neurol Sci. 2012; 319(1-2): 111–116.
6) Miyamoto N, Tanaka Y, et al.: Demographic, clinical, and radiologic predictors of neurologic deterioration in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis. 2013; 22(3): 205–210.
5) Liu P, Liu S, et al.: Association between neurological deterioration and outcomes in patients with stroke. Ann Transl Med. 2020; 8(1): 4.
36) Bernhardt J, Churilov L, et al.: Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT). Neurology. 2016; 86(23): 2138–2145.
21) Ryu WS, Schellingerhout D, et al.: Association between Serum Lipid Profiles and Early Neurological Deterioration in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2016; 25(8): 2024–2030.
24) Davidson MH, Toth PP: High-density lipoprotein metabolism: potential therapeutic targets. Am J Cardiol. 2007; 100(11 A): 32–40.
38) Bernhardt J, Collier JM, et al.: Very Early Versus Delayed Mobilization After Stroke. Stroke. 2019; 50(7): 178–179.
32) Olavarría VV, Arima H, et al.: Head position and cerebral blood flow velocity in acute ischemic stroke: a systematic review and meta-analysis. Cerebrovasc Dis. 2014; 37(6): 401–408.
29) Salinet AS, Panerai RB, et al.: The longitudinal evolution of cerebral blood flow regulation after acute ischaemic stroke. Cerebrovasc Dis Extra. 2014; 4(2): 186–197.
11) Barer D, Watkins C: Could upright posture be harmful in the early stages of stroke? Lancet. 2015; 386(10005): 1734.
9) Bernhardt J, English C, et al.: Early mobilization after stroke: early adoption but limited evidence. Stroke. 2015; 46(4): 1141–1146.
4) Yamamoto Y, Ohara T, et al.: Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits. J Neurol Sci. 2011; 304(1-2): 78–82.
17) Steinke W, Ley SC: Lacunar stroke is the major cause of progressive motor deficits. Stroke. 2002; 33(6): 1510–1516.
26) Aries MJ, Elting JW, et al.: Cerebral autoregulation in stroke: a review of transcranial Doppler studies. Stroke. 2010; 41(11): 2697–2704.
19) Bhatia K, Mohanty S, et al.: Predictors of early neurological deterioration in patients with acute ischaemic stroke with special reference to blood urea nitrogen (BUN)/creatinine ratio & urine specific gravity. Indian J Med Res. 2015; 141(3): 299–307.
7) Davalos A, Cendra E, et al.: Deteriorating ischemic stroke: Risk factors and prognosis. Neurology. 1990; 40(12): 1865–1869.
13) Yamamoto N, Satomi J, et al.: Risk Factors of Neurological Deterioration in Patients with Cerebral Infarction due to Large-Artery Atherosclerosis. J Stroke Cerebrovasc Dis. 2017; 26(8): 1801–1806.
28) Castro P, Azevedo E, et al.: Cerebral Autoregulation in Stroke. Curr Atheroscler Rep. 2018; 20(8): 37.
3) Takeuchi M, Miyashita K, et al.: Analysis of Factors Associated with Progression and Long-Term Outcomes of Penetrating Artery Territory Infarction: A Retrospective Study. J Stroke Cerebrovasc Dis. 2016; 25(8): 1952–1959.
22) Bharosay A, Bharosay VV, et al.: Effect of lipid profile upon prognosis in ischemic and haemorrhagic cerebrovascular stroke. Indian J Clin Biochem. 2014; 29(3): 372–376.
34) Lo EH: A new penumbra: transitioning from injury into repair after stroke. Nat Med. 2008; 14(5): 497–500.
25) Libby P, Ridker PM, et al.: Progress and challenges in translating the biology of atherosclerosis. Nature. 2011; 473(7347): 317–325.
10) Bernhardt J, Langhorne P, et al.: Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet. 2015; 386(9988): 46–55.
37) Dewar R, Sykes D, et al.: The effect of hemiplegia on blood pressure measurement in the elderly. Postgrad Med J. 1992; 68(805): 888–891.
30) Webb AJS, Paolucci M, et al.: Confounding of Cerebral Blood Flow Velocity by Blood Pressure During Breath Holding or Hyperventilation in Transient Ischemic Attack or Stroke. Stroke. 2020; 51(2): 468–474.
27) Petersen NH, Ortega-Gutierrez S, et al.: Dynamic cerebral autoregulation is transiently impaired for one week after large-vessel acute ischemic stroke. Cerebrovasc Dis. 2015; 39(2): 144–150.
2) Birschel P, Ellul J, et al.: Progressing stroke: towards an internationally agreed definition. Cerebrovasc Dis. 2004; 17(2-3): 242–252.
35) Markus HS: Cerebral perfusion and stroke. J Neurol Neurosurg Psychiatry. 2004; 75(3): 353–361.
31) Schwarz S, Georgiadis D, et al.: Effects of body position on intracranial pressure and cerebral perfusion in patients with large hemispheric stroke. Stroke. 2002; 33(2): 497–501.
33) Østergaard L, Jespersen SN, et al.: The role of the cerebral capillaries in acute ischemic stroke: the extended penumbra model. J Cereb Blood Flow Metab. 2013; 33(5): 635–648.
14) Aries MJ, Bakker DC, et al.: Exaggerated postural blood pressure rise is related to a favorable outcome in patients with acute ischemic stroke. Stroke. 2012; 43(1): 92–96.
1) Toni D, Fiorelli M, et al.: Progressing neurological deficit secondary to acute ischemic stroke. A study on predictability, pathogenesis, and prognosis. Arch Neurol. 1995; 52(7): 670–675.
12) Terasawa Y, Iguchi Y, et al.: Neurological deterioration in small vessel disease may be associated with increase of infarct volume. J Neurol Sci. 2008; 269(1-2): 35–40.
15) Martin AJ, Price CI: A Systematic Review and Meta-Analysis of Molecular Biomarkers Associated with Early Neurological Deterioration Following Acute Stroke. Cerebrovasc Dis. 2018; 46(5-6): 230–241.
8) 日本脳卒中学会脳卒中ガイドライン委員会（編）：脳卒中治療ガイドライン2015［追補2017］．協和企画，東京， 2015，pp. 277–278.
18) Kwon HM, Lee YS, et al.: Homocysteine as a predictor of early neurological deterioration in acute ischemic stroke. Stroke. 2014; 45(3): 871–873.
16) Duan Z, Fu C, et al.: Lesion patterns of single small subcortical infarct and its association with early neurological deterioration. Neurol Sci. 2015; 36(10): 1851–1857.
References_xml – reference: 30) Webb AJS, Paolucci M, et al.: Confounding of Cerebral Blood Flow Velocity by Blood Pressure During Breath Holding or Hyperventilation in Transient Ischemic Attack or Stroke. Stroke. 2020; 51(2): 468–474.
– reference: 20) Kim YD, Choi HY, et al.: The Ischemic Stroke Predictive Risk Score Predicts Early Neurological Deterioration. J Stroke Cerebrovasc Dis. 2016; 25(4): 819–824.
– reference: 10) Bernhardt J, Langhorne P, et al.: Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet. 2015; 386(9988): 46–55.
– reference: 7) Davalos A, Cendra E, et al.: Deteriorating ischemic stroke: Risk factors and prognosis. Neurology. 1990; 40(12): 1865–1869.
– reference: 16) Duan Z, Fu C, et al.: Lesion patterns of single small subcortical infarct and its association with early neurological deterioration. Neurol Sci. 2015; 36(10): 1851–1857.
– reference: 6) Miyamoto N, Tanaka Y, et al.: Demographic, clinical, and radiologic predictors of neurologic deterioration in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis. 2013; 22(3): 205–210.
– reference: 2) Birschel P, Ellul J, et al.: Progressing stroke: towards an internationally agreed definition. Cerebrovasc Dis. 2004; 17(2-3): 242–252.
– reference: 31) Schwarz S, Georgiadis D, et al.: Effects of body position on intracranial pressure and cerebral perfusion in patients with large hemispheric stroke. Stroke. 2002; 33(2): 497–501.
– reference: 3) Takeuchi M, Miyashita K, et al.: Analysis of Factors Associated with Progression and Long-Term Outcomes of Penetrating Artery Territory Infarction: A Retrospective Study. J Stroke Cerebrovasc Dis. 2016; 25(8): 1952–1959.
– reference: 11) Barer D, Watkins C: Could upright posture be harmful in the early stages of stroke? Lancet. 2015; 386(10005): 1734.
– reference: 15) Martin AJ, Price CI: A Systematic Review and Meta-Analysis of Molecular Biomarkers Associated with Early Neurological Deterioration Following Acute Stroke. Cerebrovasc Dis. 2018; 46(5-6): 230–241.
– reference: 34) Lo EH: A new penumbra: transitioning from injury into repair after stroke. Nat Med. 2008; 14(5): 497–500.
– reference: 12) Terasawa Y, Iguchi Y, et al.: Neurological deterioration in small vessel disease may be associated with increase of infarct volume. J Neurol Sci. 2008; 269(1-2): 35–40.
– reference: 33) Østergaard L, Jespersen SN, et al.: The role of the cerebral capillaries in acute ischemic stroke: the extended penumbra model. J Cereb Blood Flow Metab. 2013; 33(5): 635–648.
– reference: 32) Olavarría VV, Arima H, et al.: Head position and cerebral blood flow velocity in acute ischemic stroke: a systematic review and meta-analysis. Cerebrovasc Dis. 2014; 37(6): 401–408.
– reference: 8) 日本脳卒中学会脳卒中ガイドライン委員会（編）：脳卒中治療ガイドライン2015［追補2017］．協和企画，東京， 2015，pp. 277–278.
– reference: 13) Yamamoto N, Satomi J, et al.: Risk Factors of Neurological Deterioration in Patients with Cerebral Infarction due to Large-Artery Atherosclerosis. J Stroke Cerebrovasc Dis. 2017; 26(8): 1801–1806.
– reference: 27) Petersen NH, Ortega-Gutierrez S, et al.: Dynamic cerebral autoregulation is transiently impaired for one week after large-vessel acute ischemic stroke. Cerebrovasc Dis. 2015; 39(2): 144–150.
– reference: 18) Kwon HM, Lee YS, et al.: Homocysteine as a predictor of early neurological deterioration in acute ischemic stroke. Stroke. 2014; 45(3): 871–873.
– reference: 24) Davidson MH, Toth PP: High-density lipoprotein metabolism: potential therapeutic targets. Am J Cardiol. 2007; 100(11 A): 32–40.
– reference: 23) Choi KH, Park MS, et al.: Serum triglyceride level is an important predictor of early prognosis in patients with acute ischemic stroke. J Neurol Sci. 2012; 319(1-2): 111–116.
– reference: 14) Aries MJ, Bakker DC, et al.: Exaggerated postural blood pressure rise is related to a favorable outcome in patients with acute ischemic stroke. Stroke. 2012; 43(1): 92–96.
– reference: 26) Aries MJ, Elting JW, et al.: Cerebral autoregulation in stroke: a review of transcranial Doppler studies. Stroke. 2010; 41(11): 2697–2704.
– reference: 35) Markus HS: Cerebral perfusion and stroke. J Neurol Neurosurg Psychiatry. 2004; 75(3): 353–361.
– reference: 36) Bernhardt J, Churilov L, et al.: Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT). Neurology. 2016; 86(23): 2138–2145.
– reference: 1) Toni D, Fiorelli M, et al.: Progressing neurological deficit secondary to acute ischemic stroke. A study on predictability, pathogenesis, and prognosis. Arch Neurol. 1995; 52(7): 670–675.
– reference: 21) Ryu WS, Schellingerhout D, et al.: Association between Serum Lipid Profiles and Early Neurological Deterioration in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2016; 25(8): 2024–2030.
– reference: 29) Salinet AS, Panerai RB, et al.: The longitudinal evolution of cerebral blood flow regulation after acute ischaemic stroke. Cerebrovasc Dis Extra. 2014; 4(2): 186–197.
– reference: 5) Liu P, Liu S, et al.: Association between neurological deterioration and outcomes in patients with stroke. Ann Transl Med. 2020; 8(1): 4.
– reference: 17) Steinke W, Ley SC: Lacunar stroke is the major cause of progressive motor deficits. Stroke. 2002; 33(6): 1510–1516.
– reference: 38) Bernhardt J, Collier JM, et al.: Very Early Versus Delayed Mobilization After Stroke. Stroke. 2019; 50(7): 178–179.
– reference: 4) Yamamoto Y, Ohara T, et al.: Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits. J Neurol Sci. 2011; 304(1-2): 78–82.
– reference: 28) Castro P, Azevedo E, et al.: Cerebral Autoregulation in Stroke. Curr Atheroscler Rep. 2018; 20(8): 37.
– reference: 37) Dewar R, Sykes D, et al.: The effect of hemiplegia on blood pressure measurement in the elderly. Postgrad Med J. 1992; 68(805): 888–891.
– reference: 9) Bernhardt J, English C, et al.: Early mobilization after stroke: early adoption but limited evidence. Stroke. 2015; 46(4): 1141–1146.
– reference: 19) Bhatia K, Mohanty S, et al.: Predictors of early neurological deterioration in patients with acute ischaemic stroke with special reference to blood urea nitrogen (BUN)/creatinine ratio & urine specific gravity. Indian J Med Res. 2015; 141(3): 299–307.
– reference: 25) Libby P, Ridker PM, et al.: Progress and challenges in translating the biology of atherosclerosis. Nature. 2011; 473(7347): 317–325.
– reference: 22) Bharosay A, Bharosay VV, et al.: Effect of lipid profile upon prognosis in ischemic and haemorrhagic cerebrovascular stroke. Indian J Clin Biochem. 2014; 29(3): 372–376.
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Snippet 【目的】急性期虚血性脳梗塞患者において初回の背臥位から端座位への姿勢変換による血圧変動とその後の神経症状増悪との関連を検討することを目的とした。【方法】発症24 時間以内に入院した虚血性脳梗塞患者165 名を対象に初回離床時に端座位を10 分間以上行い，背臥位と比較して端座位3 分後または10...
「要旨」【目的】急性期虚血性脳梗塞患者において初回の背臥位から端座位への姿勢変換による血圧変動とその後の神経症状増悪との関連を検討することを目的とした. 【方法】発症24時間以内に入院した虚血性脳梗塞患者165名を対象に初回離床時に端座位を10分間以上行い,...
SourceID medicalonline
jstage
SourceType Publisher
StartPage 523
SubjectTerms 神経症状増悪
脳梗塞
血圧変動
Title 急性期虚血性脳梗塞患者における初回端座位時の血圧変動と神経症状増悪との関連
URI https://www.jstage.jst.go.jp/article/rigaku/47/6/47_11787/_article/-char/ja
http://mol.medicalonline.jp/library/journal/download?GoodsID=cb3physi/2020/004706/003&name=0523-0530j
Volume 47
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ispartofPNX 理学療法学, 2020, Vol.47(6), pp.523-530
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