心源性大脑中动脉栓塞后大面积脑梗死出血性转化与血压的关系

发布时间：2018-06-04 15:07

本文选题：出血性转化 + 大脑中动脉　；参考：《扬州大学》2014年硕士论文

【摘要】：[目的] 探讨大脑中动脉心源性栓塞后大面积脑梗死出血性转化与各血压参数之间的关系。 [方法] 回顾性分析了发病后24小时内入院的单侧大脑中动脉心源性栓塞的大面积脑梗死患者,筛选了其中入院时头颅CT或MR未发现出血性转化的146例,根据其7天内复查头颅Computed Tomography (CT)或Magnatic Resonance (MR)结果,分为出血性转化组(HT)和非出血性转化组(non-HT),比较分析了两组之间各血压特异性参数的关系。血压特异性参数包括：入院初始血压(initial)、均值(mean)、最大值(max)、最小值(min)、极差(max-min)、SD、连续变异性参数(sv),连续变异性参数的最大值(svmax)。其中极差(max-min)、SD、连续变异性参数(sv),连续变异性参数的最大值(svmax)被定义为血压变异性参数。最后单独比较高血压变异组与低血压变异组之间出血性转化的发生率。 [结果] 在427例入院的大面积脑梗死患者当中,其中389例符合急性大脑中动脉心源性栓塞诊断。在这些389患者当中,321例患者在发病后24小时内入院,然后因为以下原因排除了一些患者：26例入院头颅CT/MR即发现出血性转化,22例既往有卒中病史并留有明显后遗症,57例在入院后72小时之内死亡或自动出院,19例入院7d内未再有影像学检查,45例患者进行溶栓或伴随其它严重器质疾病等混杂因素,6例入院最初72小时之内没有连续血压监测。最终一共146例患者参与了我们的研究。7d内复查头颅CT/MR有77(77/146)例患者发生了出血性转化,出血性转化率为52.7%。将所有血压参数通过其四分位数分类,在这些血压参数中,SBPmin、SBPmax-min、 SBPsv、SBPsvmax、DBPinitial、DBPsd、DBPmax、DBPmax-min、DBPsv、DBPsvmax独立于患者年龄、入院时间、入院时NIHISS评分、充血性心力衰竭病史、抗血小板治疗、初始血糖、PT、INR与大脑中动脉心源性栓塞后大面积脑梗死的出血性转化显著相关(P0.05趋势拟然比检验)。除SBPinitial, SBPmean, SBPsd, DBPmean及DBPsvmax外,其他血压参数均与出血性转化显著相关。大部分血压变异性参数中(SBPmax-min, SBPsd, SBPsvmax, DBPmax-min, DBPsd, DBPsv),血压高变异组的出血性转化率要显著高于血压低变异组。 [结论] 较高的血压水平及变异性会增加大脑中动脉心源性栓塞后大面积脑梗死出血性转化的风险,对于这类患者可能需要平稳缓慢的降压。
[Abstract]:[purpose] To investigate the relationship between hemorrhagic transformation of large area cerebral infarction and blood pressure parameters after middle cerebral artery cardiogenic embolization (MCAE). [methods] The large area cerebral infarction patients with unilateral middle cerebral artery cardiogenic embolism (MCAE) admitted within 24 hours after onset were retrospectively analyzed. 146 cases of cerebral infarction with no hemorrhagic transformation on CT or Mr were selected. The patients were divided into hemorrhagic transformation group (Computed Tomography) and non-hemorrhagic transformation group (non-HTT) according to the results of Computed Tomography or Magnatic Resonance within 7 days. The relationship of blood pressure specific parameters between the two groups was compared and analyzed. The blood pressure specific parameters include: initial blood pressure, mean value, maximum value, minimum value, SDV, continuous variability parameter, and the maximum value of the continuous variability parameter, which is the maximum value of the continuous variability parameter, and the maximum value of the continuous variability parameter is the maximum value of the continuous variability parameter. Among these parameters, the maximum value of the continuous variability parameter, is defined as the blood pressure variability parameter, and the maximum value of the continuous variability parameter (svmax) is defined as the blood pressure variability parameter. Finally, the incidence of hemorrhagic transformation between hypertension variant group and hypotension variant group was compared separately. [results] Of 427 patients with massive cerebral infarction, 389 were diagnosed as acute middle cerebral artery cardiogenic embolism. Of these 389 patients, 321 patients were admitted to hospital within 24 hours after the onset of the disease. Then some patients were excluded for the following reasons: 26 patients were admitted to CT/MR, 22 patients with hemorrhagic transformation had a history of stroke and 57 patients died within 72 hours after admission or 19 patients were discharged automatically for 7 days. No imaging examination was found in 45 patients with thrombolytic therapy or other serious organ diseases. No continuous blood pressure monitoring was observed in 6 patients within 72 hours of admission. A total of 146 patients took part in our study. Within 7 days, 77,77% of 14.6 patients had hemorrhagic transformation, and the hemorrhagic conversion rate was 52.7%. All blood pressure parameters were classified according to their quartiles, in which SBPmin-SBPmax-min, SBPsvsvmax-DBPinitialdsdsmax-DBPmax-min-DBPssv-DBPsvmax were independent of age, admission time, NIHISS score at admission, history of congestive heart failure, antiplatelet therapy. There was a significant correlation between PTT INR and hemorrhagic transformation of large area cerebral infarction after middle cerebral artery embolization (MCAE). With the exception of SBPinitial, SBPmean, SBPsd, DBPmean and DBPsvmax, blood pressure parameters were significantly correlated with hemorrhagic transformation. Among the most blood pressure variability parameters, SBPmax-min, SBPsd, SBPsvmax, DBPmax-min, DBPsd, DBPsvN, the hemorrhagic conversion rate of high blood pressure variation group was significantly higher than that of hypotension variant group. [conclusion] High blood pressure levels and variability may increase the risk of hemorrhagic transformation of large areas of cerebral infarction after middle cerebral artery cardiogenic embolization, which may require a steady and slow lowering of blood pressure.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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