脑卒中合并高血压住院患者随访1年的预后及影响因素  

The prognosis of stroke patients with hypertension and its related factors based on a one-year follow-up

作　　者：罗琼[1] 黄欣 李婷[1] 周彦伦 陈焕[1] 邓平[1] 谢和宾 Luo Qiong;Huang Xin;Li Ting;Zhou Yanlun;Chen Huan;Deng Ping;Xie Hebin(Changsha Central Hospital Affiliated to University of South China,Changsha 410004,China)

机构地区：[1]南华大学附属长沙市中心医院心内科,410004

出　　处：《中华老年医学杂志》2020年第11期1269-1273,共5页Chinese Journal of Geriatrics

基　　金：湖南省卫生计生委科研计划基金资助项目(E2017221);湖南省卫生健康委员会科技计划重点项目(20201904)。

摘　　要：目的探讨脑卒中合并高血压住院患者随访1年的预后及影响因素,为临床早期识别高风险人群和干预提供依据。方法以2017年4月至2018年8月在长沙市中心医院住院的脑卒中合并高血压患者719例为研究对象,收集患者的一般资料、基础疾病史及家族史、药物治疗方案及实验室检查指标并随访1年。根据患者的预后情况分为死亡组和存活组,采用Logistic回归分析脑卒中合并高血压的死亡危险因素。结果随访期内共有77例患者死亡,死亡率为10.7%(77/719)。单因素分析发现死亡组和存活组在婚姻状况(χ^2=35.455,P<0.001).文化水平(χ^2=35.238,P<0.001)、运动习惯(χ^2=10.172,P=0.001)、体质指数(EMI)(t=2.161,P=0.031)、年龄(t=-5.976,PV0・001)、心脏病史(χ^2=5.064,P=0.024)、服用抗血小板药物(χ^2=14.275,P=0.003)、服用降压药(χ^2=14.597,P<0.001)、服用降脂药(χ^2=11.311,P=0.001)、肌酐(t=-4.63,P<0.001)差异有统计学意义。Logistic回归分析显示年龄(OR=1.042,95%CI:1.011〜1.073)、丧偶(OR=3.674,95%CI:1.558〜8.665)、文化水平(OR=0.418,95%CI:0.225〜0.779)、使用阿司匹林(OR=0.376,95%CI:0.165〜0.855),使用氯吡格雷(OR=0.451,95%CI:0.219〜0.928)、使用降压药物(OR=0R505,95%CI:0.282-0.901)、肌酐(OR=1.009,95%CI:l.004〜1.014)是患者预后的独立影响因素(P<0.05)。结论脑卒中合并高血压患者的死亡率较高,其中高龄、丧偶、肌酐值高是影响其预后的危险因素,文化水平高、服用降压药、服用抗血小板药物是其保护因素。Objective To investigate the prognosis and related factors o£stroke patients with hypertension after a one-year follow-up,in order to provide evidence for early clinical identification and intervention of high-risk groups.Methods A total of 719 stroke patients with hypertension who were hospitalized in our hospital from April 2017 to August 2018 were enrolled as the research subjects.General information,history of underlying diseases,family history,drug treatments and laboratory test results were collected.Patients were followed up for 1 year.Patients were divided into the death group and the survival group according to prognosis.Logistic regression analysis was used to identify risk factors for death in stroke patients with hypertension.Results A total of 77 patients died during the follow-up period,and the mortality rate was 10.7%(77/719).Univariate analysis showed significant differences in marital status(χ^2=35.455<0.001),education level(χ^2=35.238,P<0.001),exercise habits(χ^2=10.172,P=0.001),BMI(t=2.161,P=0.031),age(t=-5.976,P<0.001),history of heart disease(χ^2=5.064,P=0.024),antiplatelet use(χ^2=14.275,P=0.003),antihypertensive drug treatment(χ^2=14.597,P<0.001),lipid-lowering drug treatment(χ^2=11.311,P=0.001),and creatinine(t=-4.63,P<0.001)between the death group and the survival group.Logistic regression analysis showed that age(OR=1.042,95%CI:1.011-1.073),loss of a spouse(OR=3.674,95%CI:1.558-8.665),education level(OR=0.418,95%CI:0.225-0.779),use of aspirin(OR=0.376,95%CI:0.165-0.855),use of clopidogreKOR=0.451,95%CI:0.219-0.928),antihypertensive drug treatment(OR=0.505,95%CI:0.282-0.901)and creatinine(OR=1.009,95%CI:1.004-1.014)were independent influencing factors for prognosis(P<0.05).Conclusions The mortality rate is high in stroke patients with hypertension.Advanced age,loss of a spouse and high creatinine level are risk factors for prognosis,whereas high education level,antihypertensive drug treatment and antiplatelet use are protective factors for prognosis.

关 键 词：高血压 卒中 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R544.1[医药卫生—临床医学]