不同血压参数对高血压脑出血患者急性期预后的影响  

The effect of blood pressure parameters on the outcome of the patients with cerebral hemorrhage in the acute stage

作　　者：冯靓[1] 王贞[1] 张征[1] 叶祖森[1] 牛晓婷[1] 韩钊[2] 

机构地区：[1]温州医科大学附属第一医院神经内一科,浙江温州325015 [2]温州医科大学附属第二医院神经内科,浙江温州325027

出　　处：《温州医科大学学报》2018年第1期49-52,共4页Journal of Wenzhou Medical University

基　　金：温州市科技局科研基金资助项目(Y20120152)

摘　　要：目的:评估不同血压参数对高血压性脑出血患者急性期临床转归的影响。方法:连续收集2010年12月-2013年1月在温州医科大学附属第一医院神经内科急诊就诊的发病6 h内的脑出血患者,按要求完成血压监护,完成相关资料收集,随访至发病后3个月。采用非条件logistic回归分析影响发病后7 d及发病后3个月临床转归的因素。结果:入选患者66例。多因素分析提示,患者的年龄(P=0.01,OR=1.19,95%CI=1.04~1.36)、血肿体积(P<0.001,OR=1.34,95%CI=1.12~1.59)、24 h内最高收缩压(P=0.02,OR=1.10,95%CI=1.02~1.20)及发病前7 d平均收缩压(P=0.01,OR=0.79,95%CI=0.66~0.94)与患者发病7d转归独立相关;利用ROC曲线筛选界值,结果显示收缩压控制在151.5~178.5 mmHg利于患者急性期转归;患者年龄(P=0.03,OR=1.09,95%CI=1.01~1.17)及基线NIHSS评分(P=0.01,OR=1.27,95%CI=1.07~1.50)与患者3个月临床转归独立相关。结论:脑出血患者发病后24 h内最高收缩压、发病前7 d平均收缩压可以作为患者早期转归的独立预测因素,收缩压控制在151.5~178.5 mmHg有利于患者早期临床转归。脑出血患者急性期血压参数尚无法预测患者3个月临床转归。Objective： To study the effect of blood pressure parameters on the outcome of the patients with cerebral hemorrhage in the acute stage. Methods： Patients admitted in the neurology emergency clinic of the First Affiliated Hospital of Wenzhou Medical University were collected within 6 hours after onset from December 2010 to January 2013. Their blood pressure was recorded, relevant information was collected and all the cases were followed up for 3 months after stroke. Non-conditional logistic regressions analysis was adopted as the statistical method. To study the factors which affected the outcome of the first 7 days and 3 months after stroke. Results： In total 66 cases were analyzed. Multiplicity showed that the patient＇s age （P=0.01, OR=1.19, 95%CI=1.04-1.36）, the volume of hematoma （P〈0.001, OR=1.34, 95%CI=1.12-1.59）, the highest systolic pressure in the first 24 hours （P=0.02, OR=1.10, 95%CI=1.02-1.20） and the average systolic pressure in the first 7 days （P=0.01, OR=0.79, 95%CI=0.66-0.94） were the four independent factors associated with the outcome on the seventh days. The ROC curve was used to screen the boundary value, suggesting that the range of blood pressure in 151.5-178.5 mmHg was beneficial to the patients in acute period. The factors of age and the basic NIHSS were the independent factors connected with outcome of 3 months. Conclusion： The highest systolic pressure within the first 24 h （P=0.03, OR=1.09, 95%CI=1.01-1.17） and the average systolic pressure in the first 7 days （P=0.01, OR=1.27, 95%CI=1.07-1.50） could be used as the independent predictors for the outcome of acute stage of patients with cerebral hemorrhage, and a suitable range of blood pressure was beneficial for the outcome of the disease. The parameters of blood pressure could not be used as independent predictors for the outcome of 3 months in patients with cerebral hemorrhage.

关 键 词：脑出血  高血压  收缩压  多因素分析 

分 类 号：R741[医药卫生—神经病学与精神病学]