急性脑梗死患者应激性高血压的变化及与30天预后关系的研究

发布时间：2018-06-08 00:51

本文选题：脑梗死 + 应激性高血压　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]研究急性脑梗死伴应激性高血压患者的血压变化情况及与30天预后的关系。[方法]选择2015年3月-2016年11月发病24小时内入院的急性脑梗死患者,将入院患者中符合应激性高血压诊断标准者纳入研究课题,共121例。收集一般临床资料,监测入院10天内不同时间点的血压,分析血压的变化情况。同时分别在入院时、入院第10天及发病后30天应用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS 量表)和 Barthel 指数评定量表(Barthel Index,BI)评价神经功能缺损程度和日常生活能力。按照入院时NIHSS量表评分分为低评分组(≤6分)、中评分组(7～14分)、高评分组(≥15分),通过3组患者入院3天内平均收缩压(Mean Systolic Blood Pressure, MSBP)及平均舒张压(MeanDiastolic Blood Pressure, MDBP)的下降幅度比较,分析神经功能缺损程度与血压变化的关系;按照入院时BI评分分为轻度功能障碍组(60分)、中度功能障碍组(60～41分)、重度功能障碍组(≤40分),通过3组患者入院3天内MSBP及MDBP下降幅度比较,分析日常生活能力下降程度与血压变化的关系;按照入院3天内MSBP下降率分为下降率低组(5～10%)、中组(10～15%)和高组(≥15%),同时按照入院3天内MDBP下降率分为下降率低组(5～10%)、中组(10～15%)和高组(≥15%),分别分析三组患者MSBP和MDBP下降率与30天NIHSS好转率和BI评分的关系。[结果]1.对121例急性脑梗死伴应激性高血压患者入院后不同时间点的收缩压和舒张压采用配对t检验结果显示,入院时MSBP和MDBP分别与入院12h、第1天至第10天血压比较均有差异(P0.01),入院第8天MSBP和MDBP分别与第9、10天比较,差异无统计学意义(P0.05)。2.按入院时NIHSS评分分组的三组患者,高评分组患者入院时MSBP及MDBP均明显高于其他两组;高评分组患者入院3天内MSBP下降幅度大于其他两组患者,中评分组与低评分组患者比较无差异;各组患者入院3天内MDBP下降幅度均无差异。3.按入院时BI评分分组的三组患者,重度功能障碍组患者入院时平均收缩压及平均舒张压均明显高于其他两组;重度功能障碍组患者入院3天内MSBP下降幅度大于轻度功能障碍组患者,中度功能障碍患者与其他两组比较均无差异;各组患者入院3天内MDBP下降幅度均无差异。4.按入院3天内平均收缩压下降率分组的三组患者,入院第10天NIHSS好转率无差异;MSBP下降率高组(≥15%)发病后30天NIHSS好转率低于低组(5～10%),中组(10～15%)与其他两组均无差异;MSBP下降率高组(≥15%)患者入院第10天及发病后30天BI评分均低于其他两组;低组(5～10%)和中组(10～15%)患者入院第10天及发病后30天BI评分无差异。按入院3天内平均舒张压下降率分组的三组患者,入院第10天及发病后30天NIHSS好转率及BI评分均无差异。[结论]1.发病24h内入院的急性脑梗死伴应激性高血压患者,入院时收缩压及舒张压均呈升高趋势,以收缩压升高为主,入院后血压开始逐渐下降,多在入院后3天内收缩压及舒张压下降幅度最大,入院后第8天血压逐渐趋于平稳。2.重度神经功能缺损组患者入院时平均收缩压及平均舒张压均明显高于轻度和中度神经功能缺损组,入院3天内平均收缩压下降幅度均大于轻度和中度神经功能缺损组患者;未发现神经功能缺损程度与入院3天内平均舒张压下降幅度相关。3.重度日常生活能力障碍组患者入院时平均收缩压及平均舒张压均明显高于轻度和中度日常生活能力障碍组,入院3天内平均收缩压下降幅度大于轻度日常生活能力障碍患者;未发现日常生活能力下降程度与入院3天内平均舒张压下降幅度相关。4.入院3天内平均收缩压下降率超过15%组的患者30天预后较差;未发现入院3天内平均舒张压下降率与30天预后相关。5.脑梗死患者急性期应严密动态监测血压变化,谨慎降压,推荐个体化治疗。
[Abstract]:[Objective] to study the changes of blood pressure and the relationship with the 30 day prognosis in patients with acute cerebral infarction with stress hypertension. [Methods] select the patients who were hospitalized for 24 hours in March 2015 -2016 years, and put the standard of stress hypertension into the research subjects, 121 cases were collected, and the general clinical funds were collected. The blood pressure was monitored at different time points within 10 days of admission and the changes of blood pressure were analyzed. At the same time, the National Institutes of Health Stroke Scale (National Institutes of Health Stroke Scale, NIHSS scale) and Barthel index rating scale (Barthel Index, BI) were used to evaluate the nerve work at the admission, tenth days after admission and 30 days after the onset of the disease. According to the admission NIHSS scale, the scores were divided into low rating group (less than 6 points), middle evaluation group (7~14), high rating group (15), and the decrease of mean systolic blood pressure (Mean Systolic Blood Pressure, MSBP) of Ji Ping mean diastolic pressure (MeanDiastolic Blood Pressure, MDBP) in 3 groups of patients within 3 days of admission. The relationship between the degree of nerve function defect and the change of blood pressure was analyzed. According to the BI score at admission, it was divided into the mild dysfunction group (60 points), the moderate dysfunction group (60~41 points), the severe dysfunction group (less than 40 points), and the comparison of the decrease of MSBP and MDBP within the 3 days of admission to the hospital, and the relationship between the decrease of daily living ability and the change of blood pressure. The MSBP decline rate was divided into lower rate group (5 ~ 10%), middle group (10 ~ 15%) and high group (> 15%) in the 3 days of admission. At the same time, the decrease rate was divided into lower rate group (5 ~ 10%), middle group (10 ~ 15%) and high group (> 15%) in 3 days, and the relationship between the decrease rate of MSBP and MDBP and the NIHSS improvement rate and BI score of three patients were analyzed respectively. [results]1. The results of paired t test on systolic and diastolic pressure of 121 patients with acute cerebral infarction with stress hypertension at different time points after admission showed that both MSBP and MDBP were significantly different from 12h, first days to tenth days (P0.01) at admission (P0.01), and there was no significant difference between MSBP and MDBP at the day of admission and 9,10 days respectively (P0.0). 5).2. was significantly higher than the other two groups at the time of admission to the group of three groups. The MSBP and MDBP in the high evaluation group were significantly higher than those of the other two groups. The decrease of MSBP in the high evaluation group was greater than the other two groups within 3 days. There was no difference between the group and the low rating group in the 3 days. The MDBP decline of the patients in each group had no difference of.3. within the 3 days of admission. The average systolic pressure and mean diastolic pressure of the patients with severe dysfunction group were significantly higher than that of the other two groups in the three groups of BI score group. The decrease of MSBP in the patients with severe dysfunction group was greater than that of the mild dysfunction group within 3 days, and the patients with moderate dysfunction had no difference with the other two groups; the patients in each group were admitted to hospital. In 3 days, there was no difference in the decrease of MDBP in the three groups of group.4. according to the average systolic blood pressure drop rate within 3 days of admission, and there was no difference in the improvement rate of NIHSS at the tenth day of admission, and the improvement rate of NIHSS in the high group of MSBP descending (> 15%) was lower than that in the low group (5 to 10%), and the middle group (10 to 15%) was not different from that of his group; the high group of MSBP descending rate (> 15%) was admitted to hospital. Tenth days and 30 days after the onset of BI score were all lower than the other two groups, the lower group (5 ~ 10%) and the middle group (10 to 15%) patients were admitted to hospital for tenth days and 30 days after the onset of the BI score had no difference. According to the average diastolic blood pressure drop rate within 3 days of 3 days in three patients, there was no difference in NIHSS improvement rate and BI score in 30 days after admission and after the onset of disease. [conclusion]1. in the pathogenesis of 24h) The systolic pressure and diastolic pressure of the hospitalized acute cerebral infarction patients with stress hypertension were increased, the systolic pressure increased mainly, the blood pressure began to decrease gradually after admission, and the contraction pressure and diastolic pressure decreased most within 3 days after admission, and the blood pressure gradually tended to stable.2. severe nerve function defect group eighth days after admission. The average systolic pressure and mean diastolic pressure in the hospital were significantly higher than those of mild and moderate neurological deficit groups. The average systolic pressure decreased in 3 days more than those in the mild and moderate neurological deficit groups, and the degree of neural function defect was not associated with the average diastolic pressure drop within 3 days of admission.3.. The average systolic pressure and mean diastolic pressure in the hinder group were significantly higher than those in the mild and moderate daily life ability disorder group. The average systolic pressure dropped more than the mild daily life disability patients within 3 days. The decrease of daily living ability and the average diastolic pressure drop within 3 days of admission were not found to be.4. within 3 days of admission. The 30 day prognosis of the patients with the average systolic blood pressure drop over 15% groups was poor, and the average diastolic blood pressure drop rate in the 3 days of admission and the 30 day prognosis were not found. The acute phase of.5. cerebral infarction should be closely monitored and the blood pressure change should be closely monitored, and the individual treatment should be recommended carefully.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R544.1

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