Effects of an Early Intensive Blood Pressure–lowering Strategy Using Remifentanil and Dexmedetomidine in Patients with Spontaneous Intracerebral Hemorrhage: A Multicenter, Prospective, Superiority, Randomized Controlled Trial

作者：Rui Dong, Fen Li, Bin Li, Qiming Chen, Xianjian Huang, Jiehua Zhang, Qibing Huang, Ze-Li Zhang, Yunxing Cao, Mingbiao Yang, Jianwei Li, Zhanfu Li, Cuiyu Li, Guohua Liu, Zhong Shu, Guang Feng, Ming Zhang, Yumei Xiao, Kangyue Lin, Yunlong Shen, Huanzhang Shao, Yuan Shi, Xiangyou Yu, Xiaopeng Li, Lan Yao, Xinyu Du, Ying Xu, Pei Kang, Guoyi Gao, Bin Ouyang, Wenjin Chen, Zhenhua Zeng, Pingyan Chen, Chunbo Chen, Hong Yang · 发表于：Anesthesiology · 年份：2024 · DOI：10.1097/aln.0000000000004986 · 被引用次数：13 · 研究领域：Intracerebral and Subarachnoid Hemorrhage Research、Traumatic Brain Injury and Neurovascular Disturbances、Intensive Care Unit Cognitive Disorders

BACKGROUND: Although it has been established that elevated blood pressure and its variability worsen outcomes in spontaneous intracerebral hemorrhage, antihypertensives use during the acute phase still lacks robust evidence. A blood pressure-lowering regimen using remifentanil and dexmedetomidine might be a reasonable therapeutic option given their analgesic and antisympathetic effects. The objective of this superiority trial was to validate the efficacy and safety of this blood pressure-lowering strategy that uses remifentanil and dexmedetomidine in patients with acute intracerebral hemorrhage. METHODS: In this multicenter, prospective, single-blinded, superiority randomized controlled trial, patients with intracerebral hemorrhage and systolic blood pressure (SBP) 150 mmHg or greater were randomly allocated to the intervention group (a preset protocol with a standard guideline management using remifentanil and dexmedetomidine) or the control group (standard guideline-based management) to receive blood pressure-lowering treatment. The primary outcome was the SBP control rate (less than 140 mmHg) at 1 h posttreatment initiation. Secondary outcomes included blood pressure variability, neurologic function, and clinical outcomes. RESULTS: A total of 338 patients were allocated to the intervention (n = 167) or control group (n = 171). The SBP control rate at 1 h posttreatment initiation in the intervention group was higher than that in controls (101 of 161, 62.7% vs. 66 of 166, 39...