高血压并缺血性脑卒中患者血压波动与气温变化的5年随访研究

摘要

目的 探讨气温变化与急性缺血性脑卒中患者血压间的关系. 方法 回顾性分析天津医科大学第二医院2011年2月1日至2016年1月31日神经内科、干部保健科入院的新发急性缺血性脑卒中住院病例5 730例及同期的气温资料,并分析气温与急性缺血性脑卒中患者血压间的关系. 结果 5 730例缺血性脑卒中男性患者居多,伴高血压病史者4 428例(77.28％).在有高血压病史的男性收缩压和舒张压均高于女性,(153.9±21.7)mm Hg比(150.7±23.6)mm Hg(1 mm Hg=0.133 kPa)/(85.9±13.3)mm Hg比(83.0±12.5)mm Hg(均P＜0.05);随增龄,收缩压呈渐次升高的趋势,舒张压呈逐渐下降的趋势(P＜0.05).秋、冬季发病的患者收缩压和舒张压水平均略高于春、夏季发病的患者(P＜0.05).月平均最高温度及月平均最低温度均与患者的收缩压水平呈线性负相关.月平均温差与患者的收缩压及舒张压水平均呈线性正相关.月平均最高温度每下降1℃,收缩压升高0.088 mmHg;月平均最低温度每下降1℃,收缩压升高0.076 mmHg;月平均温差每增加1℃,收缩压升高1.043 mmHg,舒张压升高0.654 mmHg. 结论 高血压病是缺血性脑卒中患者的危险因素,气温变化与有高血压病史急性缺血性脑卒中患者的基线血压波动有关,气温的下降和温差的增大可引起血压的升高,秋、冬季此现象更为明显,老年患者更为严重.%Objective To explore the relationship between ambient temperature variation and blood pressure fluctuations in acute ischemic stroke patients.Methods Clinical data of 5 730 ischemic stroke patients hospitalized at the Departments of Neurology and Geriatrics of The Second Hospital of Tianjin Medical University and air temperature data during the corresponding period were retrospectively analyzed.The relationship between air temperature and blood pressure in patients with acute ischemic stroke was analyzed.Results Of 5 730 patients,4 428 (77.28％)had hypertension and most of them were male(56.26％ 3 362 cases).The systolic and diastolic blood pressure levels were higher in hypertensive males than in hypertensive females[(153.9 ± 21.7) mmHg vs.(150.7 ± 23.6)mmHg,(85.9±13.3)mmHg vs.(83.0±12.5)mmHg,1 mm Hg=0.133 kPa,both P＜0.05].The systolic pressure tended to increase and diastolic pressure tended to decrease with increasing age (both P ＜ 0.05).The systolic and diastolic blood pressure levels of patients were slightly higher in autumn and winter than in spring and summer (P ＜ 0.05).The mean monthly maximum and minimum temperature had negative correlations with the systolic blood pressure of patients.There was a linear positive correlation between the average monthly diurnal temperature range and the systolic and diastolic blood pressure.The systolic or diastolic blood pressure increased by 0.088 mmHg or 0.076 mmHg respectively with each 1 ℃ drop in the mean monthly maximum and minimum temperature.The systolic or diastolic blood pressure increased by 1.043 mmHg or 0.654 mmHg respectively with each 1 ℃ increase in the average monthly diurnal temperature range.Conclusions Hypertension is a risk factor for ischemic stroke,and ambient temperature variation is related to baseline blood pressure fluctuations in hypertensive patients with acute ischemic stroke.The temperature reduction and the increase of average diurnal temperature rang can lead to the elevation of blood pressure,which is more obvious in autumn and winter,especially in elderly patients.