三种不同病因缺血性脑卒中急性期血压与预后的关系  

Acute blood pressure course and prognosis in three different ischemic stroke subtypes

作　　者：叶祖森[1] 韩钊[1] 郑荣远[1] 王贞[1] 张征[1] 冯靓[1] 臧秋玲[1] 王苹莉[1] 

机构地区：[1]温州医学院附属第一医院脑血管科,325000

出　　处：《中华神经科杂志》2010年第1期51-55,共5页Chinese Journal of Neurology

基　　金：温州市科技局基金资助项目（Y2004A014）

摘　　要：目的探讨三种不同病因类型的缺血性脑卒中急性期血压与预后的关系。方法以温州脑卒中登记库为基础，前瞻性连续登记2007年4月至2008年4月温州医学院附属第一医院从发病到入院时间小于48h并被诊断为脑梗死的患者。采用Logistic多因素逐步回归法分析不同病因型脑梗死患者影响预后的因素。结果各病因型人院血压和急性期平均血压与预后均呈U型关系。动脉粥样硬化型、心源性栓塞型和其他病因型入院时血压在150／95mmHg（1mmHg=0．133kPa）左右，7d内平均血压140／90mmHg时预后最佳；小动脉病变型以入院时血压在130／95mmHg左右，7d内平均血压140／90mmHg时预后最佳。在动脉粥样硬化型缺血性脑卒中患者中，入院24h内收缩压下降幅度大于20mmHg使3个月的死亡和残疾风险增加4．44倍（OR4．44，95％CI1．70～11．59，P=0．002）；入院24h内舒张压下降幅度大于10mmHg使3个月的死亡和残疾风险增加3．70倍（OR3．70，95％CI 1．54～8．90，P=0．00）。心源性脑栓塞患者中，人院24h内收缩压下降幅度大于20mmHg（OR7．98，95％CI1．34～47．66，P=0．026）和舒张压下降幅度大于10mmHg（OR6．68，95％CI1．55～28．79，P=0．01）均为3个月死亡和残疾的独立危险因素。结论入院时各亚型组的血压与3个月病死和残疾率均呈U型关系，血压过高或过低患者预后均较差。对于动脉粥样硬化型患者和心源性栓塞患者，入院24h内血压下降幅度过大为其3个月预后不良的独立危险因素。Objective To investigate the relationship between blood pressure （BP） and prognosis in three different ischemic stroke subtypes. Methods The consecutive patients with a brain infarction proven on diffusion-weighted MRI who were hospitalized within 48 hours after stroke onset between April 2007 and April 2008 were registered. All subjects with acute ischemie stroke consecutively admitted to the neurological wards of the First Affiliated Hospital of Wenzhou Medical College, were registered in the Wenzhou Stroke Registry Program. Data were collected and coded at primary registration. The BP levels were studied during the initial 7 hospital days. Survival and dependency were assessed at 3 months. Outcomes were adjusted age, consciousness level, admission NIHSS score, the decline level of systolic BP, the decline level of diastolic BP, complication and so on. Logistic regression model was used to estimate the relationship between BP and prognosis. Results A U-shaped effect was observed in each subgroup between BP and prognosis. In the subgroups of atherothrombosis, eardioembolism and small artery disease, those who had a BP of 150/95 mm Hg （ 1 mm Hg =0. 133 kPa） on admission, 140/90 mm Hg on day 1-7 would have a better prognosis. In the subgroups of atherothrombosis and eardioembolism, the decrease of BP during the first 24 hours was the independent predictor of the death and disability at 3-month. In the atherothrombosis group, when the decrease of systolic BP during the first 24 hours was greater than 20 mm Hg, the risk of the death and disability at 3-month increased 4.44 times（ OR 4. 44, 95% CI 1.70-11.59, P = 0. 002）. In the atherothrombosis group, when the decrease of diastolic BP during the first 24 hours was greater than 10 mm Hg, the risk of the death/disability at 3-month increased 3.70 times（ OR 3.70, 95% CI 1.54-8.90, P = 0. 00 ）. In the cardioembolism group, the risk increased respectively 7.98 times （ OR 7.98, 95% CI 1.34-47.66, P = 0. 026） and 6. 68 times （ OR 6. 68, 95% CI 1.55-28

关 键 词：卒中 脑缺血 血压 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]