急性脑梗死患者不同血压类型与动脉硬化指数和早期病情轻重关系

发布时间：2018-03-29 20:09

本文选题：脑血管病　切入点：急性脑梗死　出处：《广西医科大学》2013年硕士论文

【摘要】：研究目的：探讨急性脑梗死患者不同血压类型与动脉硬化指数和早期病情轻重及生活质量关系。研究方法：研究对象为2012年11月至2013年2月在广西壮族自治区人民医院神经内科住院的急性脑梗死患者。对符合纳入标准的患者行24h动态血压监测(24hours Ambulatory blood pressure monitoring,24h ABPM),记录患者一般资料、动态血压监测参数,发病第7天予美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale NIHSS)评分、EQ-5D量表(健康指数、EQ-VAS得分)评分。根据入院时24hABPM监测结果,将患者分为杓型、非杓型、反杓型三组,计算出每个患者的动脉硬化指数(Ambulatory arterial stiffness index AASI),分析三组患者间一般资料及AASI的组间差异,同时分析动态血压各个参数与AASI相关性、三组血压类型患者动态血压各个参数组间差异。根据NIHSS评分评估患者神经功能缺损情况及EQ-5D量表评分评估对患者早期病情轻重及生活质量的影响。分析NIHSS评分、EQ-5D量表与AASI相关性。研究结果：1、253名脑梗死急性期患者杓型血压患者为60例,占23.72%；非杓型血压的患者94例,占37.15%；反杓型血压患者99例,占39.13%；原有高血压病史患者105人,占41.50%,入院24h进行动态血压监测提示血压增高者202人,占79.84%。2、三种血压类型患者的夜间收缩压(Night mean systolic body pressure NSBP)、夜间舒张压(Day mean Diastolic blood pressure NDBP)、夜间脉压(Night mean pulse pressure NPP)、晨起收缩压(Morning systolic body pressure MSBP)、24h收缩压(24hoursSystolic body pressure24hSBP)及24h平均动脉压(24hours mean artery pressure24hMAP)比较差异有统计学意义(P0.05)。3、三种血压类型患者的AASI比较差异有统计学意义(P0.05)。4、脑梗死急性期患者动态血压参数日间脉压(Day mean pulse pressure DPP)、NPP、24h脉压(24hours pulse pressure24hPP)、MSBP、4hSBP与AASI呈正相关(r=0.153,0.370,0.298,0.339,0.219,0.169；P0.05)。5、三种血压类型患者的NIHSS评分比较差异有统计学意义(P0.05)。6、三种血压类型患者的EQ-5D量表评分比较差异有统计学意义(P0.05)。7、AASI与NIHSS评分呈正相关(r=0.456P0.01),与EQ-5D评分呈负相关(r=-0.348,-0.286；P0.01)。研究结论：1、脑梗死急性期血压类型以非杓型和反杓型为主2、三种血压类型患者中,反杓型血压动脉硬化程度重,杓型血压动脉硬化程度轻,非杓型血压患者介于两者之间；3、反杓型血压早期神经功能缺损程度重,生活质量低；杓型血压早期神经功能缺损程度轻,生活质量高,非杓型血压患者介于两者之间。
[Abstract]:Objective : To investigate the relationship between different types of blood pressure in patients with acute cerebral infarction and the severity and quality of life in patients with acute cerebral infarction .

The results of 24 hours ambulatory blood pressure monitoring ( 24 hours ambulatory blood pressure monitoring , 24 hours ABPM ) , general data of the patient and the parameters of ambulatory blood pressure monitoring were recorded . The parameters of the patient ' s neurological deficit and the effect of EQ - 5D on the severity and quality of life were analyzed according to the results of 24 hours ambulatory blood pressure monitoring . The correlation between the scores of NIHSS and EQ - 5D and AASI was analyzed .

The results were as follows : 1 , 253 patients with acute stage of cerebral infarction had dipper type blood pressure ( n = 60 ) , accounting for 23.72 % ;
94 patients with non dipper blood pressure ( 37.15 % ) ;
99 cases ( 39.13 % ) of patients with anti - dipper blood pressure were reported .
There was a significant difference in ambulatory blood pressure ( NSBP ) , nocturnal diastolic blood pressure ( NDBP ) , nocturnal diastolic blood pressure ( NDBP ) , 24 hours systolic pressure ( 24 hours pulse pressure NPP ) , 24 hours pulse pressure ( 24 hours pulse pressure NPP ) , 24 hours systolic pressure ( 24 hours pulse pressure 24 hSBP ) , 24 hours mean arterial pressure ( 24 hours mean artery pressure 24 hSBP ) and 24 hours mean arterial pressure ( 24 hours mean artery pressure 24 hMAP ) .
There was a significant difference between the scores of the three types of blood pressure ( P0.05 ) . The scores of the EQ - 5D were positively correlated with the scores of the three types of blood pressure ( r = 0.456P0.01 ) , and negatively correlated with the EQ - 5D score ( r = - 0.348 , - 0.286 ) .
P0.01).

Conclusion : 1 . The type of blood pressure in the acute stage of cerebral infarction is the non dipper type and the anti - dipper type 2 . Among the three types of blood pressure , the anti - dipper type blood pressure arteriosclerosis degree is heavy , the dipper type blood pressure arteriosclerosis degree is mild , the non - dipper blood pressure patient is between the two ;
3 . The early neural function defect of anti - dipper type blood pressure is heavy and the quality of life is low ;
The early neurologic impairment of dipper type blood pressure is mild , the quality of life is high , and the non - dipper blood pressure patient is between the two .

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R743.33

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