急性期脑卒中血压变化及其和预后的关系

摘要

目的：探讨急性期脑卒中血压变化规律、影响因素及血压和预后的关系。方法对发病24 h以内入院的226例脑卒中患者连续监测10 d血压，随访1月死亡及6月死亡／残疾及复发情况。结果急性期脑卒中高血压的发生率为81．9％，入院后第6天血压基本稳定。多元线性逐步回归分析显示，脑卒中类型独立影响入院时血压且影响最大，高血压病史、吸烟史影响入院时收缩压（ SBP），年龄、发病至入院时间影响入院时舒张压（ DBP）。急性期脑卒中血压和预后呈U型关系，入院时血压在150／90 mmHg左右、第1～6天血压在140／90 mmHg左右预后较好。多因素Logistic回归分析显示，入院后第24小时SBP＜120 mmHg独立影响脑卒中1月死亡，入院后24小时内DBP下降程度及第42小时DBP独立影响6月死亡／残疾。亚组分析显示，入院后第24小时SBP＜120 mmHg独立影响脑梗死1月死亡，入院时SBP＜140 mmHg、入院后第24小时SBP＜120 mm-Hg及DBP＜90 mmHg均独立影响6月死亡／残疾；入院第4天平均SBP独立影响脑出血1月死亡，入院后24 h内DBP下降程度及第5天平均SBP独立影响6月死亡／残疾。结论急性期脑卒中血压常升高，血压呈自发下降趋势。急性期脑卒中血压是预后的独立影响因素。%Objective To investigate blood pressure( BP) variation and influential factors and the relationship between BP and progno-sis in patients with acute stroke.Methods 226 consecutive patients within the first 24 hours after the onset of stroke were collected and analyzed using prospective study.Basic information was collected and the BP was monitored during the first 10 hospital days. Death,disability and recurrence were followed up at 1 and 6 months after the ictus of stroke.Results 81.9% of the patients showed elevated BP values on admission,which gradually stabilized until 6 days.The multiple linear regression showed that stroke type had greatest impact on admission BP independently.Independent factors related to admission SBP were history of hypertension and smoking history and related to admission DBP were age and latency between onset of symptoms.A U-shaped relationship was found between BP and prognosis.Patients with a BP of 150/90 mmHg on admission,140/90 mmHg on day 1~6 would had a better prognosis.Multivari-able analysis with logistic regression showed that the independent BP-related predictor of death at 1 month was 24th hour SBP below 120 mmHg after admission and death/disability at 6 month were the decrease of DBP within 24 hours after admission and 42nd DBP af-ter admission.Subgroup analysis showed that the independent BP factors that influenced death at 1 month was 24th hour SBP <120mmHg after admission and death/disability at 6 month were SBP<140 mmHg on admission,SBP<120 mmHg and DBP <90 mm-Hg of 24 th hour after admission in cerebral infarction.In cerebral hemorrhage,independent BP factors affecting death at 1 month was the 4th day average SBP after admission and death/disability at 6 month were DBP reduction within 24 hours and the 5 th day average SBP after admission.Conclusion Elevated BP is common and has tendency towards spontaneous decline usually in acute stroke.BP in acute stage influences the prognosis in patients with acute stroke independently.