大动脉粥样硬化型急性缺血性脑卒中患者入院后首个24小时内血压变异与出院结局  

Blood pressure variability within the first 24 hours after admission and discharge outcome in acute ischemic stroke patients with large-artery atherosclerosis

作　　者：张宇 汤颖[2] 王红 王萍 李欣彦 赵景波 ZHANG Yu;TANG Ying;WANG Hong;WANG Ping;LI Xin-yan;ZHAO Jing-bo(Department of Epidemiology,School of Public Health,Harbin Medical University,Harbin 150081,China;Department of Neurology,First Affiliated Hvspital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学公共卫生学院流行病学教研室,黑龙江哈尔滨150081 [2]哈尔滨医科大学附属第一医院急诊神经内科,黑龙江哈尔滨150001

出　　处：《中华疾病控制杂志》2018年第8期776-780,共5页Chinese Journal of Disease Control & Prevention

基　　金：黑龙江省自然科学基金项目(D201235)

摘　　要：目的探讨急性缺血性脑卒中患者血压变异与出院结局的关系。方法从2016年4月~2017年3月监测患者入院后首个24 h内的血压,改良Rankin量表评分≥3为不良出院结局。用标准差代表血压变异,根据血压标准差的均值或中位数的临界整数分组,采用多因素Logistic回归模型分析血压标准差与出院结局的关系。结果纳入320例患者。患者入院后首个24 h内的收缩压变异越大有出院结局不良危险越大,患者入院后首个24 h内收缩压的标准差≥14有出院结局不良的危险,调整后OR(95%CI)为1.808(1.059~3.087);患者入院后首个24 h内收缩压的标准差≥15有出院结局不良的危险,调整后OR(95%CI)为1.682(1.003~2.819)。患者入院后首个24 h内的舒张压的变异与出院结局无关,经Logistic回归分析患者入院后首个24 h内舒张压的标准差<10组和≥10组与出院结局的关系,调整后OR(95%CI)为1.273(0.757~2.139);患者入院后首个24 h内舒张压的标准差<11组和≥11组与出院结局的关系,调整后OR(95%CI)为1.439(0.857~2.418)。结论大动脉粥样硬化型的急性缺血性脑卒中患者入院后首个24 h内的收缩压变异和出院不良结局有关。Objective To analyze the relationship between blood pressure variability within the first 24 hours after admission and discharge outcome in acute ischemic stroke patients with large-artery atherosclerosis. Methods First 24-hour blood pressure was monitored from April 2016 to March 2016 in patients after admission. Modified rankin scale scores≥3 was considered poor discharge outcome. Standard deviation presented blood pressure variability,patients were divided into groups according to critical values of standard deviation of blood pressure variability. The relationship between blood pressure vriability and discharge outcome was analyzed by multivariate Logistic regression analysis. Results A total of 320 patients were included. Patients with greater systolic blood pressure variability had high risk of poor discharge outcome,the standard deviation（ SD） ≥14 in systolic blood pressure（ SBP） was associated with discharge outcome,adjusted OR（ 95%CI） was 1. 808（ 1. 059-3. 087）,the SD≥15 in SBP was associated with discharge outcome,adjusted OR（ 95% CI） was 1. 682（ 1. 003-2. 819）. There was no relation between diastolic blood pressure variability within 24 hours after admission and discharge outcome,the SD≥10 in DBP was not associated with discharge outcome,adjusted OR（ 95% CI） was 1. 273（ 0. 757-2. 139）,the SD≥11 in DBP also was not associated with discharge outcome,adjusted OR（ 95% CI） was 1. 439（ 0. 857-2. 418）. Conclusions Systolic blood pressure variability within the first 24 hours after admission was associated with poor discharge outcome in acute ischemic stroke patients with large-artery atherosclerosis.

关 键 词：急性缺血性脑卒中 24H动态血压 血压变异 出院结局 

分 类 号：R54[医药卫生—心血管疾病] R743[医药卫生—内科学]