缺血性脑卒中急性期的血压及其预后价值  

Blood pressure during the acute stage of ischemic stroke and its prognostic value

作　　者：王卉[1] 贺茂林[1] 田少华[1] 毕欣伟[1] 杨宝玲[1] 

机构地区：[1]北京世纪坛医院神经内科,100038

出　　处：《中华老年心脑血管病杂志》2009年第11期855-857,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨缺血性脑卒中患者急性期血压变化规律及其对预后的影响。方法选择发病24 h内且无严重颈动脉狭窄的急性缺血性脑卒中患者127例,动态监测入院后7天内的血压。采用改良Rankin评分、Barthel指数和美国国立卫生研究院脑卒中评分,联合分析评估患者近期、远期的预后。结果发病24 h内血压增高患者91例(71.7%),患者平均动脉压在发病5天内呈明显的自发性下降,并趋于平稳。入院24 h收缩压140～159 mm Hg(1 mm Hg=0.133 kPa)或舒张压80～89 mm Hg时,发病近期、远期预后良好比率最高。以收缩压140～159mm Hg为界,患者血压每升高或降低20 mm Hg,远期预后不良增加38.2%或34.5%。以舒张压80～89 mm Hg为界,患者血压每升高或降低10 mm Hg,远期预后不良增加29.1%(P=0.014)或24.0%(P=0.021)。结论急性缺血性脑卒中患者入院24 h收缩压140～159 mm Hg或舒张压80～89 mm Hg时可能伴有较好的预后。Objective To investigate blood pressure（BP） the relation between BP and stroke outcome. Methods changes during acute ischemic stroke and A total of 127 patients with acute ischemic stroke within 24 hours after symptom onset were selected. All patients were examined with carotid duplex ultrasonography and those with ≥70% carotid stenosis were excluded. Serial BP values were collected during the 7-day period after admission. Clinical outcome was based on the combined analysis of the National Institute of Health Stroke Scale score,modified Rankin Scale score and Barthel Index on 90th day. Results 71. 7% of the patients showed elevated BP values on admission,which spontaneously declined over about 5 days. The highest frequency of favorable outcome on 90th day occurred in patients with a baseline SBP of 140 to 159 mm Hg of those with a baseline DBP of 80 to 89 mm Hg. Poor outcome on 90th day increased by 38.2% or 34. 5% for every 20 mm Hg above 160 mm Hg or every 20 mm Hg below 140 mm Hg in SBP. With DBP 80- 90 mm Hg as the demarcation,for every 10 mm Hg increase above 90 mm Hg or every 10 mm Hg fall below 80 mm Hg,the risk of poor outcome increased by 29. 1% （P = 0.014） or 24.0% （P = 0. 021） on 90th day. Conclusion to 89 mm Hg are associated with Both baseline SBP of 140 to 159 mm Hg and baseline DBP of 80 favorable outcome in patients with acute ischemic stroke.

关 键 词：脑缺血 卒中 高血压 血压监测 便携式 预后 队列研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]