脑卒中急性期血压变化规律及其与预后的关系  

Relationship between blood pressure variation and prognosis in patients with acute stroke

作　　者：刘瑞杰[1] 邵国富[1] 沈明强[1] 黄平[1] 翟国杰[1] 

机构地区：[1]苏州大学附属第二医院神经内科,215004

出　　处：《神经疾病与精神卫生》2009年第1期33-36,共4页Journal of Neuroscience and Mental Health

摘　　要：目的观察脑卒中急性期血压变化规律、影响因素及与预后的关系，为脑卒中急性期血压管理提供依据。方法收集入住苏州大学附属第二医院和苏州市市立医院神经内科发病时间在24h内的3,12例脑卒中患者。连续观察7d血压，随访6个月死亡及NHISS评分情况。采用多元线形回归、COX生存分析及相关分析。结果342例患者中脑卒中早期血压通常升高，16h下降明显，4h尤甚，48h趋于平稳。影响7d平均收缩压的因素有卒中类型、高血压史、伴发病评分，影响7d内舒张压的因素有卒中类型、高血压史、既往史评分、伴发病评分。7d内平均收缩压过高或过低早期死亡风险均较高。血压在140～160／70～80mmHg预后较好。血压变异程度与预后呈负相关。单位时间内血压变化越大预后越差。结论脑卒中急性期血压有自发下降的趋势，脑卒中急性期血压处理应谨慎、缓慢。Objective To investigate blood pressure variation and influential factors and the relationship between blood pressure and prognosis in patients with acute stroke, and to provide basis for clinical management in patients＇ blood pressure. Methods From Oct 2004 to Aug 2006, 342 consecutive patients admitted within the first 24 hours after the onset of stroke were collected and analyzed using prospective study. Basic information was collected and the blood pressure was monitored during the first 7 hospital days. Death and NIHSS score were followed up for 6 months after the onset of stroke. Multiple linear regression, Cox proportional hazards survival regression and correlation analysis were used to analyse the data. Results Blood pressure elevated in initial stage of acute stroke and decreased distinctively during the 16 hours, especially the first 4 hours. The factors that would influence both systolic and diastolic pressure include stroke type, hypertension history, and concomitant diseases. Patients with a blood pressure of 140 - 160/70 -80mmHg on day 1 - 7 would have a better prognosis. However, patients with either extremely high or low average systolic pressure in the first 7 days were generally associated with high risk of early death. Those who had greater blood pressure variation would have poor prognosis. Conclusions The blood pressure of patients in the acute phase of stroke has tendency towards spontaneous decline, should be handled slowly and cautiously during the first 7 days after stroke.

关 键 词：脑卒中 血压 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R743.302[医药卫生—临床医学]