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目的评估急性脑出血发病24 h内血压波动水平与患者90 d临床预后的关系。方法 2011年11月至2015年11月收治的230例急性自发性脑出血患者,收缩压均超过150 mm Hg,随机分为积极降压组(入院1 h内将血压降至140 mm Hg左右,106例)和对照组(入院后将血压控制到180 mm Hg以下,124例)。记录入院后24 h内不同时间段的收缩压和舒张压(32次血压值),用血压标准差(SD)、变异系数(CV)、最大-最小差值(Max-Min)来表示血压变异性(BPV)。90 d临床预后用改良Rankin量表判定:预后良好组(0~2分),预后不良组(3~6分)。结果 (1)BPV(收缩压和舒张压的SD、CV、Max-Min)在积极降压组90 d预后好与预后差者中比较差异无统计学意义(P均>0.05);BPV(收缩压的SD、CV、Max-Min和舒张压的CV、Max-Min)在对照组90 d预后好与预后差者中比较差异有统计学意义(P<0.01,P<0.05)。(2)单因素Spearman相关分析显示对照组收缩压的BPV(SD、CV、Max-Min)与临床预后呈正相关(r=0.188,P<0.05;r=0.350,P<0.01;r<0.272,P<0.01)。(3)多因素Logisitic回归分析显示,对照组收缩压的SD、CV、Max-Min与90 d临床预后相关(OR=5.12,3.48,5.12,P均<0.01);舒张压的SD、CV、Max-Min与90 d临床预后相关(OR=1.35,2.24,1.04,P均<0.01)。结论急性脑出血患者发病24h收缩压的BPV是影响90 d临床预后严重程度的重要因素,早期平稳降压有利于改善临床预后。
Objective To evaluate the relationship between the level of blood pressure fluctuation and the clinical prognosis of patients at 90 days after onset of acute cerebral hemorrhage. Methods Totally 230 patients with acute spontaneous ICH admitted from November 2011 to November 2015 with systolic blood pressure exceeding 150 mm Hg were randomly divided into active antihypertensive group (blood pressure reduced to about 140 mm Hg within 1 h after admission, 106 cases) and control group (blood pressure after admission to 180 mm Hg or less, 124 cases). Systolic blood pressure and diastolic blood pressure (32 blood pressure values) were recorded at different time points within 24 hours after admission, and blood pressure variation (SD), coefficient of variation (CV) and maximum-minimum difference (Max-Min) Sexual (BPV). 90 d clinical prognosis with modified Rankin scale to determine: good prognosis group (0 to 2 points), poor prognosis group (3 to 6 points). Results BPV (systolic and diastolic SD, CV, Max-Min) had no significant difference in the prognosis and poor prognosis of the 90-day active hypotensive group (all P> 0.05) (SD, CV, Max-Min and CV, Max-Min) were significantly different between the control group at 90-day prognosis and poor prognosis (P <0.01, P <0.05). (2) Single-factor Spearman correlation analysis showed that systolic BPV (SD, CV, Max-Min) in control group was positively correlated with clinical prognosis (r = 0.188, P <0.05; P <0.01). (3) Logistic regression analysis showed that SD, CV, Max-Min of systolic blood pressure in control group were correlated with 90-day clinical prognosis (OR = 5.12,3.48,5.12, P <0.01) Max-Min was associated with 90-day clinical outcome (OR = 1.35, 2.24, 1.04, P <0.01). Conclusion The BPV of systolic blood pressure at onset of 24 h in patients with acute cerebral hemorrhage is an important factor influencing the prognosis of 90-day clinical outcome. Early stable antihypertensive treatment is helpful to improve clinical prognosis.