脑卒中急性期动态血压变化、血压与预后关系研究

摘要

Objective:to study the rule of the dynamic blood pressure changes and the relationship be-tween blood pressure and cerebral blood flow in actue stroke patients who were admitted to hospital in 7days (1 ,3 ,7 days) .Provided the scientific basis for actue stroke in the blood pressure control and the management of cerebral blood flow is our purpose .Methods :In this study ,we selected 41 cases of acute stroke patients in ICU .We observed dynamic changes in blood pressure on ECG monitor and prognosis of patients .Result :①Blood Pressure elevated in initial stage of acute stroke ,Blood Pressure was increased increased about 87 .1% for the first time ,especially the systolic blood pressure ,and declined spontaneously with the time without specifically administrative drugs ,compared with the frist 24-hour after onset ,systolic blood pressure (SBP)and diastolic blood pressure (DBP) both had signifi-cantly decreased at the 3th and 7th day .②Patients with acute hemorrhagic stroke had significantly higher SBP and DBP than those with acute ischemic stroke .③There was a U-shaped relationship between admission SBP and 7-day Prognosis and L-shaped relationship between DBP and 7-day prognosis in the group of cerebral infarction ,However , In the group of cerebral hemorrhage ,we found a U-shaped relationship between admission SBP and 7-day Prognosis and J-shaped relationship between DBP and 7-day Prognosis .Conclusion :① Blood Pressure usually elevated inpa-tients with acute stroke ,and declined gradually with the time .Patients with hemorrhagic stroke has signifieantly higher SBP and DBP than those with ischemic stroke .The management of elevated blood pressure during acute sr-toke should be cautious appropriate and individualized .②Ipsilateral and contralateral side cerebral blood flow auto-regulation are proably both Damaged in acute stroke . .③ The level of blood pressure should control in160/90~100mmHg ,who is cerebral hemorrhage .And 160~180/90~100mmHg is the appropriate blood pressure ,who is cerebral Infarction .%目的：探讨脑卒中急性期入院7d内（第1、3、7d）血压动态变化规律，血压与卒中7d预后的关系，为脑卒中急性期血压的控制及脑血流的管理提供科学依据。方法：选择ICU急性脑卒中患者41例，利用心电监护仪观测急性脑卒中动态血压变化及预后关系。结果：①脑卒中急性期血压升高，首次血压增高者约占87．1％，以收缩压升高为主，并且存在自发性下降趋势，在无特殊降压措施的情况下与第24h相比，第72h、第7d的收缩压及舒张压均有明显的下降。②出血性卒中组急性期的收缩压及舒张压显著高于缺血性卒中组。③缺血性卒中者入院时收缩压与7d预后呈U型，舒张压与7d预后呈L型，出血性卒中患者入院时收缩压与7d预后呈U型，舒张压与7d预后呈J型。结论：①脑卒中急性期多伴有血压明显升高，伴随着时间的变化有自发性下降的倾向及趋势，出血性卒中组血压要明显高于缺血性卒中组。②脑卒中急性期脑血流的自动调节功能受损。③脑出血可将血压控制在160/90～100mmHg，而脑梗死将血压控制在（160～180）/（90～100）mmHg水平为宜。