急性出血性脑卒中患者动态血压特征及与预后的关系

发布时间：2018-05-24 21:09

本文选题：出血性脑卒中 + 动态血压　；参考：《中国动脉硬化杂志》2016年07期

【摘要】：目的研究急性出血性脑卒中患者入院7天内动态血压变化规律以及血压变化对预后的影响。方法入选141例急性新发出血性脑卒中患者,连续监测患者7天的24 h动态血压,采集每2 h奇数时点的血压值。收集患者相关临床资料,采用患者入院30天后的格拉斯哥预后评分(glasgow outcome scale,GOS)判断预后,GOS评分4~5分记为预后好组,GOS评分1~3分记为预后差组。分析患者入院收缩压(SBP)和舒张压(DBP)、7天白天SBP和DBP均值、7天夜间SBP和DBP均值及7天昼夜节律变化等与患者预后的关系。结果急性新发出血性脑卒中患者7天内24 h血压均呈逐渐下降的趋势,两组第7天24 h血压均值比第1天血压均值有明显的下降(P0.05),多因素分析显示入院24 h平均SBP高、入院格拉斯哥评分(glasgow coma scale,GCS)低、入院白细胞高、出血量多、基底节出血是出血性脑卒中患者近期不良预后的危险因素(P0.05)。结论急性出血性脑卒中患者7天各种血压指标在预后差组中偏高。患者入院时病情严重,基底节出血量大,入院第1天的平均24 h SBP高对患者的近期不良预后影响较大,重视急性期24 h血压监测尤其是凌晨的血压变化,并积极控制患者的血压和出血量有利于改善患者的预后。
[Abstract]:Objective to study the changes of ambulatory blood pressure (ABBP) in patients with acute hemorrhagic stroke within 7 days after admission and its influence on prognosis. Methods 141 patients with acute hemorrhagic stroke were enrolled. 24 h ambulatory blood pressure (ABBP) was monitored continuously for 7 days, and the blood pressure values were collected every 2 hours at odd time points. After 30 days of admission, Glasgow outcome scale score (Glasgow outcome scale) was used to judge the prognosis of the patients. The scores of 4 ~ 5 were recorded as good prognosis group and 1 ~ 3 scores as poor prognosis group. To analyze the relationship between the mean value of SBP and DBP in 7 days, SBP and DBP in 7 days and the circadian rhythm of 7 days in patients with systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results the blood pressure of the patients with acute newly hemorrhagic stroke showed a decreasing trend in 24 hours after 7 days. The mean blood pressure of 24 hours in both groups was significantly lower than that in the first day. The multivariate analysis showed that the average SBP of 24 hours after admission was higher than that of the first day. The Glasgow coma scale was low, the leukocyte was high and the amount of bleeding was high. The hemorrhage of basal ganglia was the risk factor of poor prognosis in the patients with hemorrhagic stroke (P 0.05). Conclusion 7 days after acute hemorrhagic stroke, various blood pressure indexes were higher in the group with poor prognosis. The patients were seriously ill at admission, large amount of blood loss in basal ganglia, high average 24 h SBP on the first day of admission had a great influence on the short term adverse prognosis of the patients. Attention was paid to the 24 h blood pressure monitoring, especially the early morning blood pressure changes in the acute phase. Positive control of blood pressure and blood loss is beneficial to improve the prognosis of patients.
【作者单位】：汕头大学医学院第一附属医院重症医学科;汕头大学医学院公共卫生与预防医学教研室;吉林大学中日联谊医院护理部;汕头大学医学院第一附属医院神经损伤及脊髓外科;汕头大学医学院第一附属医院血液净化科;
【基金】：广东省科技计划项目(2011B031800209,2013B021800264)
【分类号】：R743.3

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