脑梗死急性期血压达标程度对短期预后的影响

发布时间：2017-12-26 16:44

本文关键词：脑梗死急性期血压达标程度对短期预后的影响　出处：《华北理工大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的探讨脑梗死急性期血压达标程度对短期预后的影响。方法依据纳入标准选取2014年1月至2014年12月于华北理工大学附属医院住院的首发急性脑梗死患者247例,测量患者入院后第1—14天共42次血压。血压达标定义为小于140/90mm Hg且大于90/60mm Hg。血压值达标次数占血压测量总次数的百分比分即为血压达标率,根据达标率,按照4百分位法,将研究对象分为达标率25%组(54例)、达标率25%~50%组(51例)、达标率50%~75%组(64例)、达标率≥75%组(78例)。随访记录14天及30天研究对象美国卫生研究院卒中量表评分(NIHSS),采用生活自理程度Modified Rankin量表(m RS)为预后评判标准,采用单因素及多因素logisitic回归分析观察血压达标程度对短期预后的影响。结果1各暴露组一般情况的比较中入院前服用降压药、入院后降压治疗差异具有统计学意义(P0.05);各暴露组既往史比较中高血压病史的差异具有统计学意义(P0.05);各暴露组临床生化指标均无统计学差异(P0.05)。2 4组间入院NIHSS评分、14天时NIHSS评分具有统计学差异(P0.05),入院与14天时NIHSS评分改变不具有统计学差异(P0.05)。3 4组间入院时NIHSS评分、30天时NIHSS评分具有统计学差异(P0.05),入院与30天时NIHSS评分改变不具有统计学差异(P0.05)。4脑梗死急性期血压达标程度与14天预后情况分析:单因素logisitic回归分析,与血压达标率≥75%组相比,血压达标率25%组出现预后不良的危险增加了1.288倍,血压达标率25%~50%组出现预后不良的危险性增加了1.576倍,具有统计学意义(P0.05);多因素logisitic回归分析,调整年龄、高血压病史、糖尿病病史、血糖、发病前服用降压药物、降压治疗、入院NIHSS评分后,与血压达标率≥75%组相比,血压达标率25%组出现预后不良的危险增加了5.287倍,具有统计学意义(P0.05)。5脑梗死急性期血压达标程度与30天预后分析:单因素logisitic回归分析,与血压达标率≥75%组相比,血压达标率25%组出现预后不良的危险增加了1.697倍,血压达标率25%~50%组出现预后不良的危险性增加了1.670倍,具有统计学意义(P0.05);多因素logisitic回归分析,调整年龄、高血压病史、糖尿病病史、血糖、发病前服用降压药物、降压治疗、入院NIHSS评分后,血压达标程度与30天预后不良发生不具有统计学差异(P0.05)。结论1脑梗死急性期血压达标率高可降低14天死亡或生活依赖的风险。2脑梗死急性期血压达标未明显降低30天死亡或生活依赖的风险。
[Abstract]:Objective to investigate the effect of blood pressure standard on short-term prognosis in acute cerebral infarction. Methods according to the inclusion criteria, 247 patients with first episode acute cerebral infarction who were hospitalized in the Affiliated Hospital of North China University of technology from January 2014 to December 2014 were selected. 42 times of blood pressure were measured from first to 14 days after admission. The standard of blood pressure is defined as less than 140/90mm Hg and greater than 90/60mm Hg. The number of the total percentage of blood pressure standard blood pressure measurement of the total number of points is the standard rate of blood pressure, according to the standard rate of 400, according to the method, the research object will be divided into standard rate of 25% group (54 cases), the standard rate of 25%~50% group (51 cases), the standard rate of 50%~75% group (64 cases) and the compliance rate of more than 75% group (78 cases). The follow-up record for 14 days and 30 days of the US National Institutes of Health Stroke Scale (NIHSS), using Modified Rankin self-care scale (m RS) as prognostic criteria, using univariate and multivariate logisitic regression analysis to observe the effect of blood pressure on short-term prognosis. The results of the 1 general exposure group compared with statistical significance before admission admission taking antihypertensive drugs, after antihypertensive treatment difference (P0.05); the difference was statistically significant in each exposure group history comparison of the history of hypertension (P0.05); the clinical and biochemical indexes of exposed group were not statistically different (P0.05). The scores of NIHSS and NIHSS in the 24 groups were statistically different (P0.05), and there was no statistical difference between the admission and the 14 days of the NIHSS score (P0.05). The NIHSS scores and NIHSS scores at the time of admission were statistically different between the 34 groups (P0.05), and there was no statistical difference between the admission and the 30 days of the NIHSS score (P0.05). 4 acute cerebral infarction and the degree of blood pressure 14 day prognosis analysis: single factor logisitic regression analysis, and the standard rate of blood pressure of more than 75% groups, the standard rate of blood pressure risk of poor prognosis of 25% groups increased by 1.288 times, the standard rate of blood pressure in 25%~50% group the risk of poor prognosis was increased by 1.576 times, with statistical significance (P0.05); logisitic regression analysis, adjusted for age, hypertension, diabetes, blood glucose, before the onset of taking antihypertensive drugs, antihypertensive treatment, admission NIHSS score, and the standard rate of blood pressure of more than 75% groups, the standard rate of blood pressure risk of poor prognosis of 25% groups increased by 5.287 times, with statistical significance (P0.05). 5 acute cerebral infarction and the degree of blood pressure 30 day prognosis analysis: single factor logisitic regression analysis, and the standard rate of blood pressure of more than 75% groups, the standard rate of blood pressure risk of poor prognosis of 25% groups increased by 1.697 times, the standard rate of blood pressure in 25%~50% group the risk of poor prognosis with the increase of 1.670 times, with statistical significance (P0.05); logisitic regression analysis, adjusted for age, hypertension, diabetes, blood glucose, before the onset of taking antihypertensive drugs, antihypertensive treatment, admission NIHSS score, blood pressure level and 30 day prognosis had no statistically significant difference (P0.05). Conclusion the high rate of blood pressure in the acute phase of 1 cerebral infarction can reduce the risk of death or life dependence by 14 days. 2 the risk of blood pressure at the acute stage of cerebral infarction did not significantly reduce the risk of death or life dependence by 30 days.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3

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