降压方案对高血压性脑出血患者长期预后的影响  

Influence of antihypertensive regimen on the long-term prognosis of patients with hypertensive intracerebral hemorrhage

作　　者：王亚飞 卢立山[2] 苏长海[2] WANG Yafei;LU Lishan;SU Changhai(School of Pharmacy,Inner Mongolia Medical University,Inner Mongolia Autonomous Region,Hohhot010110,China;Department of Clinical Pharmacology,Ordos Central Hospital,Inner Mongolia Autonomous Region,Ordos017000,China)

机构地区：[1]内蒙古医科大学药学院,内蒙古呼和浩特010110 [2]内蒙古自治区鄂尔多斯市中心医院药剂科,内蒙古鄂尔多斯017000

出　　处：《中国当代医药》2022年第22期61-65,共5页China Modern Medicine

摘　　要：目的探索降压方案对高血压性脑出血(HICH)患者长期预后的影响。方法回顾性选取2017年1月1日至2019年12月31日某三级甲等医院神经外科出院的324例HICH患者的病例资料,根据本研究的纳入及排除标准,对符合条件的163例患者为研究对象进行病例查阅或电话回访,采用mRS评分进行功能评级。将入组的患者分为预后良好组(mRS<3分,72例)和预后不良组(mRS≥3分,91例)。首先采用单因素分析方法探讨影响HICH长期预后的因素,然后再将单因素分析结果中P<0.2或接近的因素进一步进行HICH患者1年预后不良的多因素logistic回归分析。结果单因素分析结果显示,年龄、饮酒史、入院收缩压(SBP)、住院前合并慢性病、口服降压药(类)、入院格拉斯哥昏迷(GCS)评分、出院GCS评分、多部位出血、住院后使用抗生素、血肿清除术与HICH患者预后不良相关,差异有统计学意义(P<0.05)。采用logistic回归模型进行多因素分析,结果显示,住院前合并慢性病(β=2.028,OR=7.597,95%CI=2.006~28.775)是HICH患者预后不良的独立危险因素(P<0.05),口服降压药(类)(β=-0.889,OR=0.411,95%CI=0.215~0.787)、出院GCS评分(β=-0.682,OR=0.506,95%CI=0.306~0.834)是HICH患者预后不良的保护因素(P<0.05),年龄(β=0.054,OR=1.055,95%CI=1.000~1.114)有预测HICH预后不良的趋势(P=0.05)。结论在控制了患者包括人口学特征的基线水平以及出院GCS评分、住院前合并慢性病的因素后,本研究发现静脉降压药类别数、静脉降压疗程对于HICH患者的长期预后无明显影响;使用口服降压药种类越多,患者预后可能越好。Objective To explore the influence of antihypertensive regimen on the long-term prognosis of patients with hypertensive intracerebral hemorrhage(HICH).Methods The case data of 324 patients with HICH discharged from Department of Neurosurgery of a classⅢhospital from January 1,2017 to December 31,2019 were retrospectively selected.According to the inclusion and exclusion criteria of this study,163 eligible patients were reviewed or followed up by telephone.The functional rating was performed with the modified Rankin Scale(mRS).The patients were divided into the good prognosis group(mRS<3 points,72 cases)and the poor prognosis group(mRS≥3 points,91 cases).Firstly,the factors affecting the long-term prognosis of HICH were discussed by univariate analysis,and then the factors with P<0.2 or close in the univariate analysis results were further analyzed by multivariate logistic regression analysis.Results Univariate analysis showed that age,drinking history,admission systolic blood pressure(SBP),chronic diseases before hospitalization,oral antihypertensive drugs(classes),Glasgow coma score(GCS)after admission,GCS score after discharge,multiple bleeding,history of antibiotic use after hospitalization and history of hematoma removal were significantly correlated with the poor prognosis of HICH patients,the differences were statistically significant(P<0.05).Multivariate analysis by logistic regression model showed that there were chronic diseases before hospitalization(β=2.028,OR=7.597,95%CI=2.006-28.775)was an independent risk factor for poor prognosis in patients with HICH(P<0.05).Oral antihypertensive drugs(class)(β=-0.889,OR=0.411,95%CI=0.215-0.787),discharge GCS score(β=-0.682,OR=0.506,95%CI=0.306-0.834)were protective factor for poor prognosis in patients with HICH(P<0.05).Age(β=0.054,OR=1.055,95%CI=1.000-1.114)had a tendency to predict the poor prognosis of HICH(P=0.05).Conclusion After controlling the baseline level of patients including demographic characteristics,GCS score at discharge and factors of chr

关 键 词：高血压性脑出血 血压 降压药 预后 

分 类 号：R544.1[医药卫生—心血管疾病]