脑卒中患者的夜间血压及其相关因素分析  

Related factors of nocturnal blood pressure in stroke patients

作　　者：黄慧玲[1] 陈艺莉[1] 刘晨[1] 

机构地区：[1]中山大学附属第一医院心内科,广州510100

出　　处：《岭南心血管病杂志》2015年第6期801-806,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的通过24 h动态血压监测(ABPM)评估脑卒中患者夜间血压的情况,并进一步分析其相关危险因素。方法回顾性地分析自2011年1月至2014年6月共294例因脑卒中[包括缺血性脑卒中(n=167)和出血性脑卒中(n=127)]在中山大学附属第一医院住院治疗,并接受24 h动态血压监测的患者的临床资料。夜间高血压定义为夜间(睡眠)平均血压≥120/70 mm Hg(1 mm Hg=0.133 k Pa),或正常的血压昼夜节律消失(表现为反杓型)。夜间低血压定义为平均动脉压(MAP)<70 mm Hg,或正常的血压昼夜节律消失(表现为超杓型)。结果在缺血性和出血性脑卒中患者中,分别有138(82.6%)和100(78.7%)的患者正常的血压昼夜节律消失。两组夜间高血压的患者比例分别为135例(80.8%)和97(76.4%),夜间低血压的患者比例分别为10(6.0%)和5例(3.9%)。此外,Logistic回归分析显示,入院时的收缩压,24 h舒张压以及晨峰收缩压是夜间高血压的相关因素。而夜间低血压的相关因素为24 h收缩压以及晨峰收缩压。结论超过80%的脑卒中患者存在血压昼夜模式的变化,夜间高血压尤为常见。因此,24 h动态血压监测是了解患者夜间血压波动情况的必要工具。Objectives To evaluate the presence of nocturnal hypertension and hypotension in stroke patients using ambulatory blood pressure monitoring （ABPM）. Methods From January 2011 to June 2014, 294 stroke patients who underwent ABPM in the First Affiliated Hospital of Sun Yat-Sen University were retrospectively studied. They were divided into two groups： isehemic stroke （n=167） and hemorrhagic stroke （n=127）. Nocturnal hypertension was considered when a normal circadian rhythm disappeared （shown as reverse-dippers） with a mean nocturnal blood pressure （during sleep） ≥120/70 mm Hg （1 mm Hg=0.133 kPa）. Nocturnal hypotension were considered when a normal circadian rhythm disappeared （shown as over-dippers） with a mean arterial pressure （MAP） 〈70 mm Hg. Results The normal diurnal variation of blood pressure was abolished in 138 （82.6%） ischemic and 100 （78.7%） hemorrhagic stroke patients. Nocturnal hypertension was observed in 135 （80.8%） ischemic and 97 （76.4%） hemorrhagic strokepatients, and nocturnal hypotension was obseIved in 10 （6.0%） ischemic and 5 （3.9%） hemorrhagic stroke patients respectively. Furthermore, Logistic regression analysis showed that systolic blood pressure （SBP） at admission, 24-hour diastolic blood pressure （DBP） and SBP of morning blood pressure surge （MBPS） had influences on nocturnal hypertension, while 24-hour SBP and SBP of MBPS were influencing factors of nocturnal hypotension. Conclusions Normal diurnal variation of blood pressur is abolished in more than 80% stroke patients, among which, nocturnal hypertension is prevalent. ABPM is necessmy for observation on nocturnal blood pressure fluctuations in stroke patients.

关 键 词：高血压 脑卒中 动态血压监测 夜间血压 

分 类 号：R544.1[医药卫生—心血管疾病]