血压与出血性脑梗死预后的关系探讨

目的 探讨血压与出血性脑梗死预后之间的关系.方法 回顾性分析242例急性脑梗死患者的临床资料,筛选出所有出血性脑梗死病例,比较不同血压水平（＞180/110 mm Hg;90/70～180/110 mm Hg;＜90/70 mm Hg）在出血性脑梗死患者中的分布差异.结果 所有急性脑梗死病例中,血压＜90/70 mm Hg患者10例（4.1%）,血压90/70～180/110 mm Hg患者213例（88.0%）,血压＞180/110 mm Hg患者19例（7.9%）.继发出血性脑梗死20例（8.3%）,其中血压＞180/110 mm Hg患者12例（60.0%）,死亡7例;血压＜90/70 mm Hg患者2例（10.0%）,死亡1例;血压90/70～180/110 mm Hg患者6例（30.0%）,死亡2例.两种脑梗死类型中血压＞180/110 mm Hg患者的分布差异具有统计学意义（P=0.000）,以出血性脑梗死病例比例较高;而在出血性脑梗死病例中,不同血压水平患者的预后差异分布亦具有统计学意义,血压＞180/110 mm Hg（P=0.041）及血压＜90/70 mm Hg（P=0.037）者病死率较高.结论 重度高血压（＞180/110 mm Hg）可能是出血性脑梗死发病的高危因素,病程中合并重度高血压（＞180/110 mm Hg）及低血压（＜90/70 mm Hg）的出血性脑梗死患者预后较差,合理的血压控制有助于改善其预后.     

舒张压与丘脑出血预后关系的研究

目的探讨舒张压对丘脑出血患者预后的影响。方法回顾性分析我科2000年3月至2009年6月收治的200例丘脑出血患者的临床资料,以入院初始舒张压水平为分组依据,将所有患者分为低血压组(舒张压<70mmHg)﹑正常血压组(舒张压在70～90mmHg之间)及高血压组(舒张压>90mmHg),比较不同舒张压水平患者预后分布差别。结果所有丘脑出血病例中,合并低血压者20例(10.0%),正常血压者56例(28.0%),高血压者124例(62.0%),在治疗过程中继发脑出血患者18例(9.0%),均为高血压组患者;其中,低血压组死亡病例2例(10.0%),正常血压组死亡3例(5.4%),高血压组死亡11例(8.9%),与正常舒张压患者相比较,合并低舒张压病例死亡率最高,其次为高舒张压病例(P=0.030)。结论舒张压对丘脑出血患者预后的影响具有重要作用,其中,舒张压过低及过高者提示预后不良。     

原发性高血压患者动态血压监测与眼底改变的相关性分析

目的 探讨原发性高血压患者动态血压变化与眼底改变的相关性.方法 选择原发性高血压患者124例,监测其24h动态血压,用直接检眼镜检查眼底小动脉变化,分别观察不同水平的24h舒张压、诊所舒张压、脉压与眼底小动脉改变的关系.结果 124例患者中眼底正常29例(23.39％),Ⅰ级眼底改变69例(55.65％),Ⅱ级眼底改变16例(12.90％),Ⅲ级眼底改变10例(8.06％).24 h舒张压≥90 mm Hg组与＜ 90 mm Hg组、诊所舒张压≥100 mm Hg组与＜100 mm Hg组、脉压≥50 mm Hg组与＜50 mm Hg组眼底改变差异均有统计学意义(P＜0.01或p＜0.05).结论 原发性高血压患者眼底病变程度与高血压病情密切相关,定期检测对预测心脑血管事件有重要意义.     

两种不同方法测量血压值的比较

目的 探讨不同程度高血压和正常血压人群应用两种不同测量血压的方法 ,进行分析对比血压值的差异.方法 2 000例患者分为4组正常血压组,高血压1级组,高血压2级组,高血压3级组.把听诊器胸件分别放置于血压计袖带内和袖带外测量血压并记录.结果 正常血压组血压平均值袖带外118.7/75 mm Hg,袖带内113.2/71.3 mm Hg,高血压1级组袖带外144.8/84.3 mm Hg,袖带内140.4/82.3 mm Hg,高血压2级组袖带外157.8/95.9 mm Hg,袖带内149.3/92.9 mm Hg,高血压3级组袖带外181.5/110.6 mm Hg,袖带内178.6/114.3 mm Hg.结论 正常血压组,高血压1级组,高血压2级组,袖带外收缩压和舒张压均显著高于袖带内血压(P＜0.01,P＜0.05),高血压3级组袖带内外均差异无统计学意义(P＞0.05).     

急性脑梗死患者肢体运动前后血压变化观察

目的：观察急性脑梗死患者肢体运动前后血压变化的幅度和持续时间。方法：测量86例急性脑梗死患者右侧肱动脉血压，肢体运动前测量1次，运动后即5、10、15min各测量1次，并设正常对照组。结果：肢体运动后与运动前比较，收缩压：急性脑梗死伴高血压组即刻有非常显著增高（P＜0．01）；急性脑梗死非高血压即刻有显著增高（P＜0．05）。急性脑梗死伴高血压组收缩压增高幅度大于急性脑梗死非高血压组。舒张压：急性脑梗死伴高血压组即刻有显著增高（P＜0．05）。结论：急性脑梗死患者在生命体征稳定后血压在3级以下可进行适度运动以早日康复。     

脑卒中并抑郁与血压水平的相关性分析

目的 总结分析脑卒中并抑郁与血压水平的相关性.方法 选择2010年6月～2012年11月本院收治的90例脑卒中并抑郁患者为研究对象,将其按照血压水平分为血压正常组26例、高血压A组32例、高血压B组32例,通过汉密尔顿抑郁（HAMD）评分表评定抑郁程度,分析不同血压水平脑卒中患者的抑郁情况.结果 血压正常组患者脑出血和脑梗死发生率均明显低于高血压A、B组,差异有统计学意义（P＜0.05）;高血压A、B组脑出血和脑梗死发生率差异无统计学意义（P＞0.05）.血压正常患者抑郁改善程度明显优于高血压患者,差异有统计学意义（P＜0.05）.结论 随着脑卒中患者血压的升高,其脑出血与脑卒中发生率呈上升趋势,脑卒中患者抑郁程度与血压呈正相关.     

入院高血糖与急性脑梗死预后的相关性研究

目的 探讨入院高血糖与急性脑梗死患者预后的相关性.方法 急性脑梗死患者456例根据入院血糖水平分为高血糖组（≥7.8 mmol/L）和正常血糖组（＜7.8 mmol/L）.对2组基线,治疗后24 h、14 d美国国立卫生院神经功能缺损评分（NIHSS）,90 d改良Rankin评分（mRS）,病死率,出血转化率进行统计学分析.结果 2组治疗前基本资料除糖尿病史差异有统计学意义（P=0.002）外,余差异均无统计学意义;高血糖组治疗后24 h、14 d NIHSS总评分改善、90 d mRS临床转归良好的比率均较正常血糖组差（30.0% vs 46.4%,P＜0.05）;高血糖组病死率高于正常血糖组（26.0% vs 10.3%,P＜0.05）;高血糖组症状性出血转化率高于正常血糖组（4.9% vs 1.7%,P＜0.05）.结论 入院高血糖与急性脑梗死患者预后不良相关,与病死率及症状性出血转化的增加有关. 关     

动态血压监测血压变化与高血压脑血管突发事件相关性分析

目的 探讨动态血压监测研究高血压患者血压变化与脑血管突发事件相关性的应用价值.方法 选择135例高血压患者,其中32例发生脑血管突发事件设为观察组,103例未发生脑血管突发事件设为对照组,分析两组动态血压监测结果.结果 观察组24h平均收缩压为(152±10)mm Hg、舒张压为(93±11)mm Hg,显著高于对照组的(133±11)mm Hg、(80±9)mm Hg(t=-0.256、-0.198,均P＜0.05);观察组白昼平均收缩压为(158±15)mm Hg、舒张压为(96±7)mm Hg,显著高于对照组的(137±13)mm Hg、(83±8)mm Hg(t=-0.325、-0.223,均P＜0.05);观察组夜间平均收缩压为(151±12)mm Hg、舒张压为(90±7)mm Hg,显著高于对照组的(132±14)mm Hg、(79±9)mm Hg(t =0.268、-0.166,均P＜0.05).结论 高血压患者血压动态变化与脑血管突发事件紧密相关,对脑血管突发事件的预防有指导意义.     

脑梗死急性期血压调控的临床观察

目的：观察脑梗死急性期降压治疗对临床预后的影响。方法将收缩压≥200 mm Hg或者舒张压≥110 mm Hg的60例患者随机分为治疗组和对照组各30例,治疗组用厄贝沙坦氢氯噻嗪降压,对照组第1天不使用降压药。观察2组患者发病2周的血压和神经功能缺损评分。结果2组治疗后血压与治疗前相比明显下降,差异有统计学意义（P＜0．05）。治疗组治疗第14天的神经功能评分较对照组明显改善,差异有统计学意义（P＜0．05）。结论脑梗死急性期应用厄贝沙坦氢氯噻嗪对血压进行干预是安全的。     

重型颅脑损伤低血压干预值的探讨研究

目的探讨重型颅脑损伤患者救治过程中,血压降低到何值时给予措施干预,改善其预后。方法对121例重型颅脑损伤患者进行回顾性分析研究,按患者出现的收缩压最低值分为3组,〉100 mm Hg组64例,100 mm Hg～90 mm Hg组22例,〈90 mm Hg组35例,随访6个月,进行格拉斯哥愈后评级（GOS）。结果〉100 mm Hg组死亡13例（20.31%）,重残7例（10.93%）,恢复良好44例（68.75%）;100 mm Hg～90 mm Hg组死亡11例（50%）,重残7例（31.82%）,恢复良好4例（18.18%）,〈90 mm Hg组死亡29例（82.86%）,重残4例（11.43%）,恢复良好2例（5.71%）,3组恢复情况差异有统计学意义（P〈0.01）。结论重型颅脑损伤患者救治过程中,收缩压维持在100 mm Hg以上,对患者的预后有重要意义。     

Prognostic significance of acute systolic hypertension after myocardial infarction.

The clinical behaviour and mean peak serum aspartate aminotransferase (SGOT) values of 106 patients admitted to a coronary care unit with acute myocardial infarction who displayed acute systolic hypertension were studied. Another 106 normotensive patients with acute myocardial infarction acted as controls. Neither group had established hypertension. The mortality rate, incidence of cardiac failure, major arrhythmias, and mean peak SGOT were significantly greater in the hypertensive group, within which the duration of hypertension was correlated with mean peak SGOT levels--through there was no definite relation between the height of systolic or diastolic pressure and SGOT. Transient systolic hypertension after acute myocardial infarction was therefore associated with a relatively poor prognosis, but our observations suggest that patients with a systolic blood pressure of at least 170 mm Hg might benefit from early hypotensive treatment.     

高血压脑出血开颅患者急性期血压调控及预后的临床观察

目的 观察高血压脑出血行开颅术患者急性期血压调控及对临床预后的影响.方法 将62例高血压脑出血行开颅血肿清除术患者,随机分为两组,观察组(n=31)急诊入院后即给予微量泵静脉注射乌拉地尔,监测控制血压低于150/90 mm Hg(MAP≤110 mm Hg);对照组(n=31)采用常规术前治疗,监测控制血压低于180/105 mm Hg(MAP≤130 mm Hg).术后根据病情给予常规降压治疗.比较两组患者的病死率,术后再出血率等并发症及近、远期疗效的差异.结果 观察组死亡3例,无术后再出血;对照组死亡5例,术后再出血2例,两组病死率、再出血率及术后并发症无统计学差异;近期GOS预后比较:观察组优7例,良10例,对照组优3例,良6例,两组总优良率差异有统计学意义(X2=4.23,P<0.05);两组患者远期ADL评分的比较观察组优于对照组(P<0.05).结论 高血压脑出血行开颅血肿清除术患者急性期强化降压优于常规术前治疗,能提高患者的近、远期预后.     

Long-acting lacidipine versus short-acting nifedipine in the treatment of asymptomatic acute blood pressure increase

We compared antihypertensive efficacy and safety of a single administration of equipotent doses of lacidipine versus nifedipine in the hypertensive urgencies. Twenty-nine asymptomatic essential hypertensive patients (nine men, 20 women) with a mean age of 55.03+/-11.19 years and baseline diastolic blood pressure (DBP) of > or =120 mm Hg after resting 30 min, not taking antihypertensive drugs for the last 24 h, were randomized in a single-blind fashion to receive lacidipine, 4 mg (LCD, 15 patients) or short-acting nifedipine, 20 mg (NFD, 14 patients) in a single dose. Blood pressure (BP) and heart rate (HR) were taken every 30 min during the first 8 h and every 2 h until 24 h of follow-up. Baseline BP values were similar in the two groups (LCD, 222.5+/-32.8/124.6+/-8.4 mm Hg vs. NFD, 215.9+/-20.6/128+/-7.7 mm Hg; p = NS). Both drugs promoted a significant reduction of systolic blood pressure (SBP; 169.6+/-27.8 vs. 170.6+/-25.3 mm Hg) and diastolic blood pressure (DBP; 104.1+/-16 vs. 102.9+/-12.4 mm Hg) after 8 h. However, either SBP (165+/-27.3 vs. 190.6+/-18.2 mm Hg; p = 0.008) and DBP (99.9+/-12.3 vs. 117.2+/-11.4 mm Hg; p = 0.001) were significantly higher in the NFD group after 24-h dosing. Eleven patients in the LCD group had a decrease in BP >25% of the baseline value both 8 and 24 h after the dose. Although 10 patients showed the same response in the NFD group 8 h after the dose, only four patients maintained these values at 24 h. One patient treated with NFD had a transient cerebrovascular ischemic attack. No adverse effects were observed in the LCD group. We conclude that the long-acting calcium antagonist lacidipine was more effective than the short-acting nifedipine in both controlling BP and maintaining this BP reduction over 8 h in essential hypertensive patients with acute asymptomatic BP increase.     

Antihypertensive Effect and Tolerability of Perindopril in Indian Hypertensive and Type 2 Diabetic Patients: 1-Year Randomised, Double-Blind, Parallel Study vs Atenolol

OBJECTIVE: This study compared the antihypertensive effect and acceptability of a perindopril-based group with that of an atenolol-based group in Indian hypertensive type 2 (non-insulin-dependent) diabetic patients. DESIGN AND SETTING: 100 ambulant patients aged between 35 and 69 years were recruited into this monocentric, randomised, double-blind study in two parallel groups for 1 year after a 1-month washout period on placebo. The setting was a tertiary care institution. PATIENTS: All patients had stable, essential hypertension between 95mm Hg and 115mm Hg, type 2 diabetes with glycosylated haemoglobin (HbA(1C)) <12%, and albuminuria between 300mg and 3.5g/24 hours. There were 50 patients per treatment group and two patient population groups were studied, intention-to-treat (ITT) and per-protocol (PP). The former constituted all patients, whilst the latter included those without major protocol deviation and who completed the 12-month study. INTERVENTIONS: The study drugs were perindopril 4 to 8mg once daily or atenolol 50 to 100mg once daily. In each group therapeutic adjustment was planned by doubling the dose and then by the addition of hydrochlorothiazide 25mg daily. Nifedipine 30 to 60mg daily was subsequently added if the desired drop in blood pressure was not obtained. The ITT group was analysed by Student's t-test, and a 2-way analysis of variance was performed for the PP population. MAIN OUTCOME MEASURES: A comparison of the control of hypertension, biochemical abnormalities, blood sugar and adverse effects was performed in the atenolol group versus the perindopril group. RESULTS: On single-dose therapy after 1 month 17 patients (60%) had normal blood pressure [diastolic blood pressure (DBP) 相似文献   

阿卡波糖治疗老年糖尿病伴餐后低血压的疗效及安全性分析

目的分析阿卡波糖治疗老年糖尿病伴餐后低血压的临床疗效与安全性。方法 74例糖尿病伴餐后低血压老年患者,均给予阿卡波糖治疗。对比治疗前后收缩压、舒张压、平均动脉压(MAP)最大降幅、肠系膜上动脉血流最大增幅、餐后血糖最大增幅,分析治疗后餐后低血压发生情况及不良反应发生情况。结果治疗后,患者收缩压、舒张压、平均动脉压最大降幅、肠系膜上动脉血流最大增幅、餐后血糖最大增幅分别为(22.93±6.877)mm Hg(1 mm Hg=0.133 kPa)、(9.82±4.27)mm Hg、(3.59±2.11)mm Hg、(364.75±87.05)ml/min、(2.13±0.98)mmol/L,均显著小于治疗前的(32.15±10.53)mm Hg、(12.73±4.84)mm Hg、(11.56±3.71)mm Hg、(487.63±112.03)ml/min、(3.49±1.79)mmol/L,差异具有统计学意义(P<0.05)。治疗后餐后低血压发生率为40.54%(30/74)。治疗后7例(9.46%)患者发生轻微消化道反应,其中4例腹泻, 3例腹胀,停药后症状改善,未发生严重心脑...     

Dose-response effect of sublingual captopril in hypertensive crises

Forty-one patients, presenting in the Emergency Service of the Hospital General y Clinico, Tenerife, with symptoms of hypertensive crisis and supine diastolic blood pressure (DBP) greater than 120 mm Hg, were studied. They received 12.5 mg of sublingual captopril and 30 minutes later, if diastolic blood pressure (DBP) was not 100 mm Hg or less, the same dose was repeated by the same route. Supine systolic blood pressure (SBP), DBP and heart rate (HR) were monitored at 0, 5, 10, 15, 30, 45, 60, and 120 minutes after each administration of captopril. In 27 patients (66%) had a satisfactory response (DBP less than or equal to 100 mm Hg), after a single dose, less than 30 minutes after administration, which persisted at 120 minutes. In 14, a second administration was necessary after 30 minutes, and a satisfactory response to the second dose, defined again as DBP reaching values of 100 mm Hg or less, was achieved in 12 of them (29% of the total group). In two patients (5% of total) no full response was obtained. The observed pattern of response suggests that a sublingual dose of 25 mg of captopril is the minimum effective dose, but it is also possible that administration of 12.5 mg of sublingual captopril at 10 to 15 minute intervals, perhaps up to a maximum dose of 37.5 mg, might be considered as an alternative treatment in hypertensive crises.     

老年急性脑卒中患者六个月预后影响因素分析

目的 分析老年急性脑卒中6个月预后情况及影响因素.方法 收集2008年1月至2011年8月重庆市中山医院收治的急性脑卒中老年患者210例的病历资料进行回顾性分析,根据患者6个月时预后分组,通过Logistic回归分析总结影响显示预后的因素.结果 单因素分析结果显示年龄、心脏病史、美国国立卫生研究所脑卒中评分量表(NIHSS)评分、坚持康复治疗、空腹血糖、白蛋白以及收缩压和舒张压是影响老年急性脑卒中患者6个月预后的因素(均P＜0.05).多因素分析结果显示年龄、NIHSS评分＞7分、空腹血糖＞7.8 mmol/L、收缩压≥140mmHg(1 mmHg=0.133 kPa)和/或舒张压≥90 mm Hg是老年急性脑卒中患者6个月预后的独立危险因素,而白蛋白＞35 g/L是其独立保护因素.结论 老年急性脑卒中发生后年龄过大、NIHSS评分＞7分、空腹血糖＞7.8 mmol/L、收缩压≥140 mm Hg和/或舒张压≥90 mm Hg往往提示预后不良,而白蛋白＞35 g/L提示预后可能较好,可以通过坚持康复训练改善预后.     

高血压患者血压变异性与脑梗死发病关系的探讨

目的探讨血压变异性（BPV）与高血压患者脑梗死发病的关系。方法收集2008年1月一2010年5月因头颅DWI诊断为新发脑梗死而住院的高血压患者797例,其中半年内规范降压且检查过24h动态血压的共31例,将其与同期半年内接受过相同降压治疗和检查的无新发脑梗死的高血压患者共42例进行比较。将资料分为钙拮抗剂组（CCB,43例）及非钙拮抗剂组（nCCB,30例）,其中CCB组又分为拜心同（Procardin,26例）和络活喜（Norvasc,17例）2亚组。以单因素分析比较各分组或亚组间血压的变异性,以二项分类Logistic回归分析影响高血压患者发生脑梗死的因素。结果CCB组高血压患者脑梗死的发生率低于nCCB组（X^2=12．378,P=-0．002）;高血压伴有脑梗死组BPVsBP及BPVDBP高于不伴脑梗死组（t=-6．324,P=0．000;t=-2．822,P=0．006）,但2组间24h平均收缩压（SBP）及平均舒张压（DBP）差异无显著性（P〉0．05）;BPVSBP在Procardin、Norvasc及nCCB3组中呈渐增高趋势且差异有显著性（P〈0．01）;BPVsBF是脑梗死发病的危险因素（0R=9．94E＋40,P=0．000）,CCB类药物是脑梗死发病的保护性因素（OR=0．049,P=0．015）。结论血压的变异性是高血压患者发生脑梗死的独立危险因素;CCB类降压药,特别是拜心同,可以通过降低血压的变异性来降低高血压患者脑梗死的发生率,使患者获得更大的收益。