动脉瘤性蛛网膜下腔出血急性期血压变异性研究

摘要

目的 分析急性动脉瘤性蛛网膜下腔出血(aSAH)病人血压变异性(BPV)的特征,并探讨动态血压监测的临床价值.方法 回顾性分析采用动态血压监测的急性aSAH病人370例,其中15例入院后再次出血(再次破裂组),355例未出血(未再破裂组).比较分析两组病人平均收缩压、平均舒张压、BPV及出院时改良Rankin量表评分差异.结果 入院后再次破裂组24 h平均收缩压为(138.7±12.6) mmHg,显著高于未再破裂组的(127.4± 10.1) mmHg,差异具有统计学意义(P=0.000);而两组平均舒张压差异不具有统计学意义(P=0.224).BPV结果提示:再次破裂组收缩压BPV和舒张压BPV分别为12.8％±7.7％、11.9％±7.3％,分别明显高于未再破裂组的10.5％±6.4％ 、9.3％±5.4％ (P=0.000、0.035).未再破裂组出院时改良Rankin量表评分明显优于再次破裂组(P=0.000).不同预后分级病人平均收缩压和收缩压BPV差异均具有统计学意义(P＜ 0.05).结论 急性期aSAH病人收缩压、BPV对动脉瘤再次破裂及预后具有重要影响,动态血压监测对急性期aSAH病人具有重要的临床价值.%Objective To analyze the characteristics of blood pressure variability (BPV) in the acute phase of patients with acute aneurysmal subarachnoid hemorrhage (aSAH) exploring the clinical values of ambulatory blood pressure monitoring (ABPM).Methods Clinical data of 370 patients with acute aSAH were analyzed retrospectively,who received ABPM.The re-rupture after admission occurred in 15 patients,who were set as re-rupture group,and the remaining 355 patients as non-rupture group.The mean systolic blood pressure (mSBP),mean diastolic blood pressure (mDBP) and BPV after admission and modified Rankin Scale on discharge were comparatively analyzed between patients in the re-rupture group and non-rupture group.Results The mSBP was (138.7 ± 12.6) mmHg in the re-rupture group 24 h after admission,which was significantly higher than 127.4 ± 10.1 in the non-rupture group (P =0.000).But there was no significant difference in mDBP between the re-rupture and non-rupture groups (P =0.224).The BPV results showed that systolic BPV and diastolic BPV were 12.8％ ± 7.7％ and 11.9％ ± 7.3％ respectively in the re-rupture group,which were higher than 10.5％ ± 6.4％ and 9.3％ ± 5.4％ in the non-rupture group (P =0.000,0.035).The modified Rankin Scale score at discharge was better in non-rupture group than in re-ruptured group (P =0.000).There were significant differences in mSBP and systolic BPV between the different grades of prognosis (P ＜ 0.05).Conclusion For aSAH patients in the acute phase,the SBP and BPV has great influence on re-rupture of aneurysm and prognosis,and ABPM has important clinical values.