脑卒中急性期血压变化规律及其与预后的相关研究

发布时间：2018-02-09 22:57

本文关键词： 脑卒中血压变化规律影响因素脑卒中血压预后　出处：《苏州大学》2013年硕士论文　论文类型：学位论文

【摘要】：第一部分脑卒中急性期血压的变化规律及影响因素的研究目的：研究脑卒中急性期血压的变化规律，分析其影响因素。方法：收集发病24小时内入院的急性脑卒中患者1461例。监测入院后7天内血压，对患者既往相关病史及病程中伴发疾病进行评分，，记录入院后血压的治疗情况等。观察入院后7天内的血压变化规律，分析其影响因素。对所得数据进行统计分析。结果：（1）脑卒中急性期血压升高，以收缩压升高为主，79.3%的患者入院时收缩压升高，并且存在自发性下降趋势，入院后血压在8小时内下降最显著，36小时后血压趋于稳定。（2）出血性卒中患者各时间点血压均显著高于缺血性卒中患者（P=0.000），前者在入院96小时后趋于稳定，后者在入院36小时后基本稳定。（3）缺血性卒中患者TOAST分型后大动脉粥样硬化型收缩压高于其他各亚型（P0.05）。各亚型入院后血压均呈下降趋势，大动脉粥样硬化型血压变化趋势较其他各型平稳。（4）既往有高血压史者的入院时收缩压、第1天平均收缩压和7天内平均血压高于无高血压史者（P0.05）。有高血压史规律服药组与不规律或未服药组之间血压无显著性差异（P0.05）。总体入院后降压治疗组急性期各时间点血压水平高于未降压组（P=0.000）。（5）颈部血管病变组与无颈部血管病变组各时间点血压、24小时血压下降率和7天血压连续性变异率比较无显著性差异（P0.05）。颈部血管斑块组与狭窄组比较亦无显著性差异（P0.05）。（6）独立影响急性期血压的主要因素有卒中类型、伴发疾病评分、高血压史和年龄。年龄与入院时舒张压、第1天和7天平均舒张压呈负相关。结论：脑卒中急性期血压升高，并有自发性下降趋势。出血性卒中患者血压要高于缺血性卒中患者。独立影响卒中急性期血压的主要因素有卒中类型、伴发疾病评分、高血压史和年龄。年龄与各时间点舒张压呈负相关。第二部分脑卒中急性期血压与预后的相关研究目的：研究脑卒中急性期血压与预后的关系。方法：收集发病24小时内入院的急性脑卒中患者1461例。监测入院后7天内血压，对患者既往相关病史及病程中伴发疾病进行评分，记录入院后血压的治疗情况以及病情变化等。评价入院时和6个月后患者神经功能缺损程度（采用美国国立卫生研究院卒中量表，NIHSS）和日常生活能力（采用Barthel Index，BI）。终点事件为发病6个月时死亡和死亡/残疾。对所得数据进行统计分析。结果：（1）脑卒中急性期入院时收缩压、第1天和7天平均收缩压均与不良预后呈J型关系，收缩压在90~120mmHg时预后最好，随着收缩压的升高6月死亡率和死亡/残疾率增加。舒张压在70~80mmHg时预后最好。缺血性卒中患者第1天平均收缩压与不良预后呈J型关系，收缩压在90~120mmHg时预后最佳。7天平均舒张压与不良预后呈U型关系，舒张压在70~80mmHg时预后最好。入院时收缩压及舒张压与预后无关（P0.05）。出血性卒中第1天和7天平均收缩压与6月预后呈U型关系，收缩压在140~160mmHg时预后最好。（2）总体24小时舒张压下降率与预后呈U型关系，血压下降率在0~10%时预后最好，血压下降率低于或高于此范围预后皆差。7天血压连续性变异率与预后呈U型关系，变异率在5~10mmHg时预后最佳。缺血性卒中组7天血压连续性变异率在5~10mmHg时预后最好。缺血性卒中组24小时血压下降率各分组间预后无显著性差异（P0.05）。出血性卒中组血压7天血压连续性变异率在5~15mmHg之间时预后最好。出血性卒中组24小时血压下降率与预后无关（P0.05）。（3）经Logistic回归分析，独立影响6月预后的血压因素为：入院时收缩压、血压连续性变异率（包括收缩压和舒张压）。整体影响6月预后的因素有年龄、既往史评分、伴发疾病评分、入院时神志、NIHSS评分、7天加重和降压治疗。结论：卒中急性期血压与预后大致呈J型关系，与收缩压关系更密切，随着收缩压的升高死亡率和死亡/残疾率增加。舒张压在70~80mmHg时预后最好。24小时血压下降率在0~10%时预后最好。7天血压连续性变异率在5~10mmHg时预后最好。入院时收缩压、血压连续性变异率（包括收缩压和舒张压）独立影响6月预后。
[Abstract]:Study on the changes and influencing factors of blood pressure in the first part of the acute stage of stroke
Objective: To study the changes of blood pressure in acute cerebral apoplexy and analyze its influencing factors.
Methods: 1461 patients with acute stroke were collected within 24 hours from onset. The blood pressure within 7 days after admission of patients monitoring, medical history and the course of diseases were recorded after admission blood pressure treatment. The variation of blood pressure was observed within 7 days after admission, and analyze its influence factors. Statistical analysis on the data.
Results: (1) blood pressure in acute stroke increased with elevated systolic blood pressure, 79.3% patients with elevated systolic blood pressure, and the presence of spontaneous decreased blood pressure after admission in 8 hours decreased significantly, 36 hours after the blood pressure tends to be stable. (2) hemorrhagic stroke patients at each time point of blood pressure was significantly higher than that in patients with ischemic stroke (P=0.000), the former tends to be stable in 96 hours after admission, the latter in 36 hours after admission is basically stable. (3) TOAST in ischemic stroke patients after classification of large artery atherosclerosis with systolic blood pressure higher than other subtypes (P0.05) subtypes. After admission, blood pressure decreased, large artery atherosclerosis blood pressure change trend is the steady. (4) a previous history of hypertension of the admission systolic blood pressure, mean blood pressure of first days and 7 days average systolic blood pressure higher than those without hypertension history (P0.05). Regular medication group and no history of hypertension There was no significant difference between the regular or non medicine group blood pressure (P0.05). The overall level of blood pressure after admission of antihypertensive treatment in acute stage of each time point was higher than the blood pressure group (P=0.000). (5) cervical vascular lesions group and no neck vascular disease group at each time point of blood pressure, blood pressure decline rate of 24 hours and 7 days of continuous blood pressure mutation rate showed no significant difference (P0.05). Carotid plaque group and stenosis group had no significant difference (P0.05). (6) a type of stroke independent factors related to acute blood pressure, concomitant disease score, history of hypertension and age. Age and diastolic blood pressure on admission, first days and the 7 day average diastolic blood pressure was negatively correlated.
Conclusion: the blood pressure in acute stroke increased, and decreased spontaneous hemorrhagic stroke. Blood pressure is higher than that of patients with ischemic stroke. A stroke type independent main influencing factors of blood pressure in patients with acute stroke, comorbidity score, history of hypertension and age. Age and diastolic blood pressure at each time point was negatively correlated.
The correlation of blood pressure and prognosis in the second part of acute stroke
Objective: To study the relationship between blood pressure and prognosis in the acute stage of stroke.
Methods: 1461 patients with acute stroke were collected within 24 hours from onset. The blood pressure within 7 days after admission of patients monitoring, medical history and the course of diseases were recorded after admission blood pressure treatment and changes of disease. Patients with neurological deficits on admission and after 6 months (the United States National Institutes of health stroke scale, NIHSS) and the ability of daily life (Barthel Index, BI). End point events for 6 months after onset of death and death / disability. The obtained data were statistically analyzed.
Results: (1) hospitalized acute stroke when the systolic blood pressure, first days and 7 days average systolic blood pressure were associated with poor prognosis in J, systolic blood pressure in 90~120mmHg when the best prognosis, with elevated systolic blood pressure of the June mortality and death / disability rate increased. Diastolic blood pressure at 70~80mmHg. The prognosis of ischemic first stroke patients day average systolic blood pressure and adverse outcomes were J type relationship, systolic blood pressure at 90~120mmHg days.7 the best prognosis of average diastolic blood pressure was correlated with poor prognosis of U, diastolic blood pressure in 70~80mmHg. The best prognosis when admission systolic blood pressure and diastolic blood pressure and prognosis (P0.05). Hemorrhagic stroke first days and 7 days the average systolic blood pressure and prognosis in June was U, the systolic blood pressure in 140~160mmHg when the best prognosis. (2) the overall rate of decline was 24 hour diastolic blood pressure U and prognosis, blood pressure decline rate in 0~10% when the best prognosis, blood pressure decline rate is lower or higher than this range of prognosis All.7 days continuous blood pressure variation rate was U and prognosis, the mutation rate in 5~10mmHg. The best prognosis of ischemic stroke group 7 days continuous variation rate of blood pressure in 5~10mmHg. The best prognosis of ischemic stroke group 24 hours blood pressure decline rate among different groups with no significant difference (P0.05). Blood pressure stroke group 7 days continuous blood pressure variation rate of the best prognosis between 5~15mmHg. Hemorrhagic stroke group 24 hours blood pressure decline rate and prognosis (P0.05). (3) by Logistic regression analysis, independent prognostic factors affecting blood pressure in June for admission systolic blood pressure, blood pressure variability (including continuous systolic and diastolic the influence factors of pressure). In June the prognosis scores of medical history, age, comorbidity score, consciousness on admission, NIHSS score, 7 days increase and antihypertensive treatment.
Conclusion: acute stroke blood pressure and prognosis is approximately J, and a closer relationship with systolic blood pressure, systolic blood pressure increased the mortality and death / disability rate increased. The diastolic pressure in 70~80mmHg prognosis.24 hours best blood pressure decline rate in 0~10% when the best prognosis.7 days of continuous variation in blood pressure rate 5~10mmHg the best prognosis. The admission systolic blood pressure, blood pressure variability (including continuous systolic and diastolic blood pressure) June independent influence prognosis.

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R743.3

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