脑出血急性期不同血压参数与预后的关系  

Association of Admission Blood Pressure with Outcome in Cerebral Hemorrhage

作　　者：宋新杰[1] 姜睿璇 张怡君 王安心 李子孝[1,2,3] 赵性泉 SONG Xinjie;JIANG Ruixuan;ZHANG Yijun;WANG Anxin;LI Zixiao;ZHAO Xingquan(Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;China National Clinical Research Center for Neurological Diseases,Beijing 100070,China;Center of Stroke,Beijing Institute of Brain Disorders,Collaborative Innovation Center for Brain Disorders,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心,北京100070 [2]国家神经系统疾病临床医学研究中心 [3]首都医科大学脑重大疾病研究中心,北京脑重大疾病研究院,脑重大疾病防治省部共建协同创新中心

出　　处：《中国卒中杂志》2022年第7期769-773,共5页Chinese Journal of Stroke

基　　金：国家重点研发计划(2018YFC1705003);北京市科委医药协同科技创新研究专项(Z201100005620010);中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-029)。

摘　　要：目的通过中国国家卒中登记Ⅱ(China national stroke registryⅡ,CNSRⅡ)的数据,分析入院收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)及平均动脉压(mean arterial pressure,MAP)与脑出血患者死亡和功能结局的关系。方法收集CNSRⅡ数据库中自发性脑出血患者的人口学信息和临床数据,应用logistic回归分析患者入院时不同SBP分层、SBP、DBP和MAP对患者短期和长期预后(包括院内死亡、3个月死亡及预后不良和1年预后不良)的影响。结果共有1048例脑出血患者的资料纳入统计分析,平均年龄62.1±12.5岁,男性666例(63.5%)。入院时平均SBP为162.1±28.9 mmHg,平均DBP为95.1±17.6 mmHg,平均MAP为117.4±20.1 mmHg。与入院SBP 120~139 mmHg的患者相比,入院SBP 180~199 mmHg(OR 17.53,95%CI 2.25~136.66,P=0.0063)和SBP≥200 mmHg的患者(OR 21.74,95%CI 2.74~172.55,P=0.0036)的在院死亡风险均增加。入院SBP每升高10 mmHg,患者在院死亡风险(OR 1.25,95%CI 1.14~1.37,P<0.0001)、3个月预后不良(OR 1.08,95%CI 1.02~1.15,P=0.0066)和死亡风险(OR 1.13,95%CI 1.04~1.22,P=0.0049)均增加。入院DBP每升高10 mmHg,患者在院死亡风险(OR 1.36,95%CI 1.16~1.59,P=0.0001)、3个月预后不良(OR 1.16,95%CI 1.05~1.29,P=0.0034)和死亡风险(OR 1.20,95%CI 1.05~1.38,P=0.0093)均增加。入院MAP每升高10 mmHg,患者在院死亡风险(OR 1.37,95%CI 1.20~1.57,P<0.0001)、3个月预后不良(OR 1.13,95%CI 1.04~1.23,P=0.0044)和死亡风险(OR 1.20,95%CI 1.06~1.35,P=0.0036)均增加。结论入院SBP、DBP和MAP水平是脑出血患者院内死亡和3个月预后不良的独立危险因素,但对患者1年预后不良无独立影响。Objective To explore the relationship between admission blood pressure(BP)and outcomes in patients with cerebral hemorrhage.Methods This study collected the data of patients with spontaneous intracerebral hemorrhage from the China National Stroke RegistryⅡ(CNSRⅡ)database.Logistic regression model was used to analyze the relationship between systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP)and the outcomes(including in-hospital death,3-month death,3-month poor prognosis and 1-year poor prognosis),after adjusting for the confounding factors.Results A total of 1048 patients were included in this study,with an average age of 62.1±12.5 years and 666 males(63.5%).At admission,the average SBP was 162.1±28.9 mmHg,the average DBP was 95.1±17.6 mmHg,and the average MAP was 117.4±20.1 mmHg.Compared with patients with SBP 120-139 mmHg at admission,the patients with SBP 180-199 mmHg(OR 17.53,95%CI 2.25-136.66,P=0.0063)and SBP≥200 mmHg(OR 21.74,95%CI 2.74-172.55,P=0.0036)had a higher in-hospital mortality rate.The risk of in-hospital mortality(OR 1.25,95%CI 1.14-1.37,P<0.0001),3-month poor prognosis(OR 1.08,95%CI 1.02-1.15,P=0.0066),and 3-month mortality(OR 1.13,95%CI 1.04-1.22,P=0.0049)all increased per an increase of 10 mmHg in admission SBP.The risk of in-hospital mortality(OR 1.36,95%CI 1.16-1.59,P=0.0001),3-month poor prognosis(OR 1.16,95%CI 1.05-1.29,P=0.0034),and 3-month mortality(OR 1.20,95%CI 1.05-1.38,P=0.0093)all increased per an increase of 10 mmHg in admission DBP.The risk of in-hospital mortality(OR 1.37,95%CI 1.20-1.57,P<0.0001),3-month poor prognosis(OR 1.13,95%CI 1.04-1.23,P=0.0044),and 3-month mortality(OR 1.20,95%CI 1.06-1.35,P=0.0036)all increased per an increase of 10 mmHg in admission MAP.Conclusions Admission SBP,DBP and MAP levels were independent risk factors for in-hospital death and 3-month poor prognosis in patients with intracerebral hemorrhage,but were not associated with 1-year poor prognosis.

关 键 词：脑出血 脑血管病 血压 预后 死亡 危险因素 

分 类 号：R743.34[医药卫生—神经病学与精神病学]