非心源性脑梗死患者急性期血压变异与早期神经功能恶化的相关性研究

摘要

Objective To explore the relationship between 24-hour blood pressure variability after admission and early neurological deterioration in patients with acute non-cardioembolic ischemic stroke.Methods This was a case-control study.Patients with acute non-cardioembolic ischemic stroke within 72 hours after stroke onset were prospectively registered.Clinical and 24 -hour continuous blood pressure monitoring data were recorded, and subsequently compared with regard to whether early neurological deterioration ( END) occurred within 7 days after admission.Factors contributing to END were investigated by logistic regression model.Results Of 221 eligible patients, 59 cases ( 26.7%) exhabited END.Patients with END had higher 24-hour mean systolic blood pressure ( SBP) (145.8 ±18.2 mmHg vs.139.9 ± 20.3 mmHg, P=0.014) and SBP coefficient of deviation (SBP-CV) [9.0(7.3 -11.2) vs.8.4(6.9-10.2), P=0.011].After adjusting for crude variables, multivariate analysis showed that the increase in mean SBP (10 mmHg mean SBP,OR=1.285,95%CI(1.059~1.559) and SBP-CV [1 unit of SBP-CV, OR=1.206,95%CI(1.050~1.384)] was associated with higher risk of END.Conclusions Increased 24-hour blood pressure variability after admission is an independent risk factor for occurrence of END in patients with acute non-cardioembolic ischemic stroke.%目的探讨非心源性脑梗死患者急性期24 h血压变异和早期神经功能恶化的关系。方法采用病例对照研究方法连续登记急性非心源性脑梗死患者，收集一般临床资料，连续血压监测并计算24 h血压变异的各参数，按照入院7 d内有无发生脑梗死早期神经功能恶化进行分组比较，建立Logistic回归模型分析24 h血压和血压变异参数与早期神经功能恶化的关系。结果221例入组患者中59例（26.7％）出现早期神经功能恶化。出现早期神经功能恶化组24 h平均收缩压和收缩压变异系数显著高于未发生组[（145.8±18.2）mmHg vs．（139.9±20.3）mmHg；9.0（7.3～11.2） vs．8.4（6.9～10.2）]，差异均有统计学意义（P＜0.05）。多因素校正后，24 h平均收缩压水平和收缩压变异系数增大是发生早期神经功能恶化的独立危险因素（每10 mmHg 24 h平均收缩压OR＝1.285，95％CI（1.059～1.559）；收缩压变异系数OR＝1.206，95％CI（1.050～1.384））。结论入院后24 h收缩压变异增大是急性非心源性脑梗死7d内发生早期神经功能恶化的危险因素。