急性缺血性脑卒中患者入院24小时血压波动最大值对预后的影响

王红; 汤颖; 张宇; 许科; 赵景波

Abstract

王红,汤颖,张宇,许科,赵景波.急性缺血性脑卒中患者入院24小时血压波动最大值对预后的影响[J].Chinese journal of Epidemiology,2018,39(5):682-685

急性缺血性脑卒中患者入院24小时血压波动最大值对预后的影响

Effect of maximum blood pressure fluctuation on prognosis of patients with acute ischemic stroke within 24 hours after hospital admission

Received:October 17, 2017

DOI：10.3760/cma.j.issn.0254-6450.2018.05.028

KeyWord: 缺血性脑卒中血压最大值出院预后

English Key Word: Ischemic stroke Maximum of blood pressure Prognosis at discharge

FundProject:黑龙江省自然科学基金（D201235）

Author Name	Affiliation	E-mail
Wang Hong	Department of Epidemiology of School of Public Health, Harbin Medical University, Harbin 150081, China
Tang Ying	Department of Neurology, The First Affiliated Hospital, Harbin Medical University, Harbin 150081, China
Zhang Yu	Department of Epidemiology of School of Public Health, Harbin Medical University, Harbin 150081, China
Xu Ke	Department of Epidemiology of School of Public Health, Harbin Medical University, Harbin 150081, China
Zhao Jingbo	Department of Epidemiology of School of Public Health, Harbin Medical University, Harbin 150081, China	zhaojb168@sina.com

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Abstract:

目的探讨急性缺血性脑卒中患者入院24 h血压波动最大值与出院预后的关系。方法 2016年4月至2017年3月在哈尔滨医科大学附属第一医院急诊神经内科，连续收集发病24 h内入院的急性缺血性脑卒中患者，并按照高血压诊断标准将患者分组，采用床旁监护仪测量入院24 h内动态血压值及收集患者基线资料，并在其出院时进行NIHSS评分，分析24 h内SBP及DBP波动最大值与出院预后关系。结果共纳入521例急性缺血性脑卒中患者，正常血压组82例，高血压组439例。正常血压组24 h内SBP和DBP波动的最大值均服从正态分布（均P>0.05），SBP波动最大值以均值146.6 mmHg（1 mmHg=0.133 kPa）为界分组，调整年龄、性别、文化程度、体力活动、人均月收入、吸烟、饮酒、高血压史、糖尿病史、冠心病史、房颤史、脑卒中病史、血脂、血糖、同型半胱氨酸、BMI、入院时NIHSS评分后，与血压波动最大值<146.6 mmHg相比，≥146.6 mmHg与出院预后不良的OR值（95% CI）为2.669（0.594～11.992）；DBP波动最大值以均值90.0 mmHg为界分组，调整上述相关因素后，与DBP波动最大值<90.0 mmHg相比，≥90.0 mmHg与出院预后不良的OR值（95% CI）为0.416（0.087～1.992）。高血压组24 h内SBP和DBP波动最大值均不服从正态分布（均P<0.05），SBP最大值以中位数171.0 mmHg为界分组，调整上述相关因素后，波动最大值越大，出院预后不良的风险越大，OR值（95% CI）为1.636（1.014～2.641）；DBP波动最大值以中位数98.0 mmHg为界，调整上述相关因素后，波动最大值越大，出院预后不良的风险越大，OR值（95% CI）为1.645（1.003～2.697）。结论入院时为正常血压的急性缺血性脑卒中患者，入院24 h内SBP和DBP波动最大值与出院预后无关；入院时为高血压的急性缺血性脑卒中患者，入院24 h内SBP和DBP波动最大值与出院不良预后有关联。

English Abstract:

Objective To investigate the relationship between the maximum blood pressure fluctuation within 24 hours after admission and the prognosis at discharge. Methods The patients with ischemic stroke admitted in Department of Neurology of the First Affiliated Hospital of Harbin Medical University within 24 hours after onset were consecutively selected from April 2016 to March 2017. The patients were grouped according to the diagnostic criteria of hypertension. Ambulatory blood pressure of the patients within 24 hours after admission were measured with bedside monitors and baseline data were collected. The patients were scored by NIHSS at discharge. The relationships between the maximum values of systolic blood pressure (SBP) or diastolic blood pressure (DBP) and the prognosis at discharge were analyzed. Results A total of 521 patients with acute ischemic stroke were enrolled. They were divided into normal blood pressure group (82 cases) and hypertension group (439 cases). In normal blood pressure group, the maximum values of SBP and DBP were all in normal distribution (P>0.05). The maximum value of SBP fluctuation was set at 146.6 mmHg. After adjustment for potential confounders, the OR for poor prognosis at discharge in patients with SBP fluctuation ≥ 146.6 mmHg was 2.669 (95% CI:0.594-11.992) compared with those with SBP fluctuation <146.6 mmHg. The maximum value of DBP fluctuation was set at 90.0 mmHg, and the adjusted OR for poor prognosis at discharge in patients with DBP fluctuation ≥ 90.0 mmHg was 0.416 (95% CI:0.087-1.992) compared with those with DBP fluctuation <90.0 mmHg. In hypertension group, the maximum values of SBP and DBP were not in normal distribution (P<0.05). The maximum value of SBP fluctuation was set at median 171.0 mmHg. After adjustment for the confounders, the greater the maximum of SBP, the greater the risk of poor prognosis at discharge was, the OR was 1.636 (95% CI:1.014-2.641). The maximum value of DBP fluctuation was set at median 98.0 mmHg. After adjustment for the confounders, the greater the maximum of DBP, the greater the risk of poor prognosis at discharge was, the OR was 1.645 (95% CI:1.003-2.697). Conclusion In acute ischemic stroke patients with normal blood pressure at admission, the maximum values of SBP and DBP within 24 hours after admission had no relationship with prognosis at discharge. In acute ischemic stroke patients with hypertension at admission, the maximum values of SBP and DBP within 24 hours after admission were associated with poor prognosis at discharge.

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