Analysis of intracranial pressure pulse wave in experimental hydrocephalus

Much has been written about the relationship between the pulse pressure (PP) of the intracranial pressure pulse wave (ICPPW) and ventricle dilatation. Some data suggest that high PP is the cause of ventricle dilatation, and other authors have reported that high PP results from decreased intracranial compliance. In order to clarify these points, the amplitude of PP and pressure-volume response (PVR: an indicator of intracranial complicance) were measured in bilateral ventricles using Hochwald's hydrocephalic model (right-left difference in ventricle size is clear due to hemicraniectomy). Hydrocephalus was induced by means of intracisternal injection of a kaolin powder solution to dogs. The mean ICP, amplitude of the PP, PVR and ventricle size (estimated by MR imaging) were evaluated in pathologic conditions induced by the following procedures. Group A, control: kaolin-induced hydrocephalus without craniectomy; group B: kaolin-induced hydrocephalus with right-sided craniectomy; group C: kaolin-induced hydrocephalus with right-sided craniectomy and dural resection; group D: kaolin-induced hydrocephalus with right-sided craniectomy, dura resection and temporal muscle resection. Using MR imaging, the same degree of symmetrical ventricle dilatation was identified in all groups except group D. Group D alone demonstrated a difference in ventricular size (craniectomy side > non-craniectomy side). There was no appreciable difference in mean ICP between any two groups. However, the amplitude of PP and the PVR decreased stepwise from group A to group D. The difference in the amplitude of the PP and PVR between the right and left ventricles was not significant in any group. Even on the larger ventricle side (right) in group D, the amplitude of PP was the same as that of the left ventricle, and much smaller than in other groups. The results of our research suggest that: (1) There was no relation between ventricle dilatation and the amplitude of PP. This means that the increased amplitude of PP was not the cause of the ventricle dilatation in this model. (2) A high degree of correlation exists between the amplitude of PP and the PVR. This means that PP can be a good parameter of intracranial compliance in this modelPresented at the Consensus Conference: Hydrocephalus '92, Assisi, Italy, 26–30 April 1992     

Profile and associations of central pulse wave velocity and central pulse pressure among ischemic stroke patients

Arterial stiffness, a known risk factor for atherosclerosis, can be measured directly with carotid–femoral pulse wave velocity (CPWV) and indirectly with central pulse pressure (CPP). We aimed to compare central and brachial pulse pressures, and to profile CPWV and CPP among ischemic stroke patients. We studied 198 consecutive prospective ethnic Chinese and South Asian ischemic stroke patients, measuring brachial pressures, central pressures and CPWV under standardized conditions using established methods. The mean CPWV was 11.6 ± 3.2 m/s and CPP was 64 ± 28 mmHg. CPP was significantly lower than brachial pulse pressure. CPWV and CPP were both independently associated with older age and hypertension. Among ischemic stroke patients, brachial pulse pressure cannot be used as a surrogate for CPP. Older age and hypertension are associated with arterial stiffening.     

高龄老年高血压患者血压昼夜节律和脉压变化特征探讨

目的探讨高龄老年高血压患者血压昼夜节律和脉压变化的特点。方法将老年高血压患者346例按年龄分为2组:老年高血压组(A组)186例,年龄60~79岁;高龄老年高血压组(B组)160例,年龄80~99岁。分析2组患者动态血压参数、动态血压昼夜节律异常发生率。结果24h平均舒张压(24hDBP)高龄老年高血压组低于老年高血压组(P0.001)。老年高血压组和高龄老年高血压组24h动态脉压(24hAPP)分别为(62.06±11.79)和(66.73±11.45)mmHg。日间平均压(dABP)老年高血压组高于高龄老年高血压组(P0.01)。24hAPP老年高血压组低于高龄老年高血压组(P0.001)。老年高血压组和高龄老年高血压组血压昼夜节律异常率分别为82.80%和90.63%。结论老年高血压患者随着年龄的增大,24hDBP呈现降低趋势,24hAPP呈现增高趋势。老年高血压患者血压昼夜节律特征多数表现为非杓型和反杓型血压,且多数血压昼夜节律消失。随增龄变化老年高血压患者昼夜节律异常率增高,增龄是血压昼夜节律消失的一个重要因素。     

Responses of intracranial pressure (ICP) produced by stimulating the pressor area in the brainstem at various levels of blood pressure and ICP in cats

Abstract An increase in intracranial pressure (ICP) was produced by stimulating brainstem pressor sites in cats anesthetized with α-chloralose. The ICP responses were augmented by lowering prestimulus BP and reduced by elevating prestimulus BP. In contrast, stimulus-induced pressor response of BP showed no consistent correlation to prestimulus BP. When the mean amplitude of stimulus-induced ICP responses at the control prestimulus ICP (within 18 mmHg) was plotted against the mean of the prestimulus BP levels for each site examined, the sites were classified into 2 groups by the regression line; sites generating a marked ICP response above the line and those generating a small ICP response on and under the line. The former sites were located in the paramedian region of the reticular formation including nuclei parvocellularis and gigantocellularis. The latter sites scattered throughout the brainstem pressor area. The ICP response at the former sites was markedly increased at an elevated prestimulus ICP. The peak ICP response at 30–50 mmHg of prestimulus ICP was 70–100 mmHg, similar to plateau waves. The ratio of ICP response size to BP response size was negatively correlated to prestimulus BP and the regression line was 2–5 times steeper at an elevated prestimulus ICP (18–60 mmHg) than at the control ICP. On the other hand, the negative relation between the response ratio and the BP for the latter sites produced no such change at the increased prestimulus ICP. These findings suggest that the ICP response is produced primarily by neurogenic intracranial vasodilation, which works most effectively at moderately decreased cerebral perfusion pressure. This mechanism may be involved in a series of events that results in plateau waves.     

高血压患者夜间血压变化与颅内动脉粥样硬化狭窄的相关性

目的探讨高血压患者夜间血压变化与颅内动脉粥样硬化狭窄(ICAS)的相关性。方法对高血压患者进行动态血压监测和脑血管磁共振血管成像(MRA)检查。颅内大动脉内径狭窄程度≥50%定义为ICAS,ICAS病灶数≥2定义为多发性ICAS。根据日间与夜间平均血压水平,将昼夜血压变化分为杓型、非杓型、反杓型。结果共359例高血压患者进入本研究:ICAS患者135例,单发性ICAS 86例,多发性ICAS 49例;226例(63.0%)日间平均血压升高,322例(89.7%)夜间平均血压升高;杓型37例(10.3%),非杓型166例(46.2%),反杓型156例(43.5%)。多因素Logistic回归分析提示:日间平均血压升高、夜间平均血压升高、夜间血压非杓型改变、夜间血压反杓型改变均与ICAS无显著相关性(P0.05);夜间血压反杓型改变与多发性ICAS密切相关(P0.05)。结论夜间血压反杓型改变可能是多发性ICAS的独立危险因素。     

体检心电图P波增宽与手测血压分析

目的通过单位体检常规心电图与手测血压分析,了解心电图P波增宽(P≥0.12 s)与高血压的关系。方法回顾性分析5726例体检人员常规12导联心电图与手测血压值,研究心电图P波增宽与高血压的关系。结果 5726例受检者中,P≥0.12 s者1315例(22.97%),P<0.12 s者4411例(77.03%)。1315例P≥0.12 S者中,290例手测血压高,(22.05%);4411例P<0.12 s中,547例(12.40%)手测血压高。二者对比,差异有统计学意义(P<0.05)。结论心电图P波增宽与高血压密切相关,定期检查心电图,观察P波时限,可早期发现高血压心脏电学改变。     

Non-invasive measurement in intracranial pressure and analysis of the pulse waveform

Non-invasive measurement of the intracranial pressure (ICP) via the anterior fontanelle by using an applanation transducer has been performed. Recently, a new fontanometer using an applanation transducer has been developed in our department by improving the conventional Statham tranducer, P-50 which is currently accepted for its high reliability. In this study, by analysing patterns of the ICP pulse waves obtained from this new fontanometer, its clinical evaluation has been made in 27 neonates and infants in intracranial pathologies. Analysing the ICP waveforms, the first peak (P₁) was divided by the following second peak (P₂) and the changes in P₁/P₂ were examined. A differential amplifier, a dP/dt detector, was also used to make it easier to identify the turning point on the pulse waves.

The results obtained demonstrated that the waveforms of ICP in neonates as well as infants are influenced by not only the intracranial constituents but compliance of the container such as the scalp, cranium and the meninges.     

Carbon dioxide induced changes in cerebral blood flow and flow velocity: role of cerebrovascular resistance and effective cerebral perfusion pressure

In addition to cerebrovascular resistance (CVR) zero flow pressure (ZFP), effective cerebral perfusion pressure (CPPe) and the resistance area product (RAP) are supplemental determinants of cerebral blood flow (CBF). Until now, the interrelationship of PaCO₂-induced changes in CBF, CVR, CPPe, ZFP, and RAP is not fully understood. In a controlled crossover trial, we investigated 10 anesthetized patients aiming at PaCO₂ levels of 30, 37, 43, and 50 mm Hg. Cerebral blood flow was measured with a modified Kety-Schmidt-technique. Zero flow pressure and RAP was estimated by linear regression analysis of pressure–flow velocity relationships of the middle cerebral artery. Effective cerebral perfusion pressure was calculated as the difference between mean arterial pressure and ZFP, CVR as the ratio CPPe/CBF. Statistical analysis was performed by one-way RM-ANOVA. When comparing hypocapnia with hypercapnia, CBF showed a significant exponential reduction by 55% and mean V_MCA by 41%. Effective cerebral perfusion pressure linearly decreased by 17% while ZFP increased from 14 to 29 mm Hg. Cerebrovascular resistance increased by 96% and RAP by 39% despite these concordant changes in mean CVR and Doppler-derived RAP correlation between these variables was weak (r=0.43). In conclusion, under general anesthesia hypocapnia-induced reduction in CBF is caused by both an increase in CVR and a decrease in CPPe, as a consequence of an increase in ZFP.     

血液透析患者颈-股动脉脉搏波速度改变及其影响因素

背景：维持性血液透析患者颈-股动脉脉搏波速度改变受多种因素影响。 目的：探讨维持性血液透析患者颈-股动脉脉搏波速度改变及其相关因素分析。 设计、时间及地点：相关性分析,交叉对照实验,于2006-01/08北京大学第三医院肾脏内科完成。 对象：北京大学第三医院临床情况稳定的66例维持性血液透析患者。 方法：收集患者一般情况、生化学指标、颈-股动脉脉搏波速度和主观综合营养状态的评估等4个方面资料。根据SGA营养评分将患者分为营养正常组49例、营养不良组17例。比较两组脉搏波速度的差异,采用单因素相关和多因素回归分析探讨脉搏波速度的相关因素。 主要观察指标：患者颈-股动脉脉搏波速度,血白蛋白和甲状旁腺激素。 结果：血液透析患者颈-股动脉脉搏波速度与年龄(r=0.284,P=0.021)、收缩压(r=0.468,P < 0.001)、脉压(r=0.451,P < 0.001)存在显著正相关,与透前血清肌酐(r=-0.347,P=0.004)、转铁蛋白(r=-0.284,P < 0.05)、血前蛋白 (r=-0.318,P < 0.05)、血浆白蛋白(r=-0.263,P < 0.05)和甲状旁腺激素(r=-0.167,P < 0.05)存在负相关。多元逐步回归分析显示脉压和甲状旁腺激素是颈-股动脉脉搏波速度的独立影响因素。采用SGA营养评估营养状态,营养不良组颈-股动脉脉搏波速度明显增快,与营养正常组比较差异有显著性意义(P < 0.05)。 结论：脉压是维持性血液透析患者颈-股动脉脉搏波速度独立的影响因素。营养不良与动脉粥样硬化是维持性血液透析常见的并发症,两者关系密切,营养不良者脉搏波速度值增高。     

Increased brachial-ankle pulse wave velocity is independently associated with risk of cerebral ischemic small vessel disease in elderly hypertensive patients

OBJECTIVE: Increased arterial stiffness is an independent predictor of cardiovascular diseases in hypertensive patients. Hypertension and aging can cause similar damage to small vessel walls. The objective of this study was to determine relationship between arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV) and the risk of cerebral small vessel disease (SVD) in elderly people with hypertension. METHODS: We studied 196 elderly subjects with hypertension (> or =50 years of age) who had neither large vessel stroke nor cardiac embolism. These patients were divided into three groups based on the results of brain MRI: (1) those with first-ever small vessel stroke; (2) those with asymptomatic subcortical ischemia; and (3) a control group with hypertension. RESULTS: The baPWV was significantly increased in the patients with first-ever small vessel stroke or asymptomatic subcortical infarction when compared to the control group, after adjusting for systolic blood pressure (SBP), pulse pressure (PP), and hs-CRP (p=0.005). Among subjects with SVD on MRI, the number of lacunar infarcts (LIs)> or =5 was significantly related to a higher baPWV (p=0.02). The relationship between the severity of periventricular white matter hyperintensities (PWMH) and the degree of baPWV became insignificant after adjustment for age. CONCLUSION: Increased baPWV was significantly associated with the risk of SVD in elderly persons with hypertension. Therefore, the measurement of baPWV could be used to predict SVD.     

Effects of electrical stimulation on intracranial pressure and systemic arterial blood pressure in cats: Part I: Stimulation of brain stem

It has been suggested that brain stem activity is involved in the occurrence of pressure waves. Different sites in the brain stem were activated by electrical stimulation in cats anaesthetized with sodium pentobarbital, to produce an increase in intracranial pressure (ICP) similar to the pressure waves. Then the effect of artificial ventilation on the occurrence of the pressure wave-like response produced under spontaneous respiration was examined since Lundberg’s A-waves appear even in artificial ventilation, and B-waves are effaced during artificial ventilation. This results in a brain stem map of ICP and systemic arterial blood pressure (BP) produced by electrical stimulation during spontaneous respiration. Stimulation of the rostral medullary reticular formation produced a rise in ICP and BP in association with a change in the rhythm of the spontaneous respiration; with artificial ventilation, stimulation produced a rise in BP but ICP kept almost at the same level. However, the rise in ICP that was produced by stimulation of the caudal medullary reticular formation during spontaneous respiration also occurred with a depressor response of BP during controlled ventilation. The pressure wave-like responses could be classified, therefore, into two types. One was the response seen during both spontaneous and controlled ventilation, which we designated the ‘α’ wave. The other was the response seen only during spontaneous ventilation, the ‘β’ wave. These observations suggest that the origins of A- and B-waves may be related to those of ‘α’ and ‘β’ waves, respectively.     

Concurrent changes in intracranial pressure,cerebral blood flow velocity,and brain energy metabolism in rabbits with acute intracranial hypertension

The relationship between intracranial pressure or cerebral perfusion pressure (CPP), cerebral blood flow, and brain energy failure is unpredictable throughout the development of acute intracranial hypertension. The purpose of the present study was to correlate intracranial pressure with cerebral blood flow velocities and brain energy metabolism in adult rabbits. The acute intracranial hypertension was achieved by pressure transmission. Transcranial Doppler waveforms were obtained from the basilar artery for monitoring cerebral blood flow velocities. ³¹P-Magnetic resonance spectroscopy was used to assess brain energy metabolism. The diastolic blood flow velocity began to decrease significantly (34.5%) when the intracranial pressure was equal to half the diastolic arterial pressure for a CPP of 36±18 mmHg. Circulatory cerebral resistances increased significantly (55%) for the same value of CPP. Diastolic frequency was near zero when intracranial pressure approached diastolic arterial pressure (51±12 mmHg), corresponding to a CPP of 30±15 mmHg. At the same time, only a tendency for brain energy metabolism to decrease was observed. Consequently, transcranial Doppler sonography could be proposed for the followup of intracranial hypertension. Magnetic resonance spectroscopy could help to monitor these patients and could be especially proposed in case of high intracranial pressure (near diastolic arterial pressure). The joint ue of these two methods would help in making appropriate therapeutic decision in humans.     

Long-term lowering of blood pressure after carotid and vertebrobasilar ischemic stroke

We followed up 107 patients experiencing a first-ever ischemic stroke after having been affected by essential hypertension for at least one year, in order to analyze the phenomenon of post-stroke blood pressure lowering. Of the 82 patients still surviving after three months of follow-up, 44 (54%) had normal arterial blood pressure values. There were no significant differences between these normotensive patients and the 38 with high blood pressure in terms of cerebrovascular risk factors or disability, but blood pressure normalized in 34 of the 54 patients experiencing a carotid stroke (63%) and in only 10 of the 28 experiencing vertebrobasilar stroke (36%) (p=0.035). These data may offer a starting point for further studies of the neurogenesis of arterial hypertension.

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Sommario Al fine di analizzare il fenomeno della normalizzazione della pressione arteriosa dopo ictus cerebrale in pazienti prima ipertesi, abbiamo osservato 107 soggetti con primo ictus ischemico, che erano già precedentemente affetti da ipertensione arteriosa da almeno un anno. Degli 82 (77%) sopravvissuti a tre mesi di follow-up, 44 (54%) hanno mostrato una normalizzazione della pressione arteriosa. L'incidenza di fattori di rischio per malattia cerebrovascolare e disabilità grave non è risultata significativamente diversa nel gruppo degli ipertesi rispetto ai normotesi. Tuttavia la normalizzazione della pressione arteriosa è stata osservata in 34 dei 54 pazienti con ictus carotideo (63%) e solo in 10 dei 28 con ictus vertebrobasilare (36%) (p=0.035). Riteniamo che tali dati offrano uno spunto per ulteriori ricerche sulla genesi neurogena dell'ipertensione arteriosa essenziale.

     

高血压病患者血压各参数与其并发脑卒中的关系

目的探讨高血压病患者血压各参数与其发生脑卒中的关系。方法回顾性分析798例高血压病患者。年龄45．65岁,其中单纯高血压病患者400例,高血压并发脑卒中者398例,分析两组患者的血压各参数关系,探讨收缩压、舒张压、平均血压、脉压与高血压并发脑卒中的相关性。结果收缩压、平均血压、脉压：脑卒中组与单纯高血压组比较有显著性差异（P〈0．05,P〈0．01）;舒张压：脑卒中组与单纯高血压组比较无显著性差异（P〉0．05）。结论中老年高血压病患者,收缩压、平均血压、脉压与脑卒中的发生有显著相关性,舒张压与脑卒中的发生无显著相关性。     

Spontaneous oscillations of arterial blood pressure,cerebral and peripheral blood flow in healthy and comatose subjects

Abstract

Slow and rhythmic spontaneous oscillations of cerebral and peripheral blood flow occur within frequencies of 0.5-3 min~1 (0.008-0.05 Hz, B-waves) and 3-9 min~1 (0.05-0.15 Hz, M-waves). The generators and pathways of such oscillations are not fully understood. We compared the coefficient of variance (CoV), which serves as an indicator for the amplitude of oscillations and is calculated as the percent standard deviation of oscillations within a particular frequency band from the mean, to study the impairment of generators or pathways of such oscillations in normal subjects and comatose patients in a controlled fashion. With local ethic committee approval, data were collected from 19 healthy volunteers and nine comatose patients suffering from severe traumatic brain injury (n = 3), severe subarachnoid hemorrhage (n = 3), and intracerebral hemorrhage (n = 3). Cerebral blood flow velocities were measured by transcranial Doppler ultrasound (TCD), peripheral vasomotion by finger tip laser Doppler flowmetry (LDF), and ABP by either non-invasive continuous blood pressure recordings (Finapres method) in control subjects, or by direct radial artery recordings in comatose patients. Each recording session lasted ~ 20-30 min. Data were stored in the TCD device for offline analysis of CoV. For CoV in the cerebral B-wave frequency range there was no difference between coma patients and controls, however there was a highly significant reduction in the amplitude of peripheral B-wave LDF and ABP vasomotion (3.8 ±2.1 vs. 28.2 ± 76.7 for LDF, p < 0.00 7; and 1.2±0.7 vs. 4.6±2.8 for ABP, p < 0.001) This observation was confirmed for spontaneous cerebral and peripheral oscillations in the M-wave frequency range. The CoV reduction in peripheral LDF and ABP oscillations suggest a severe impairment of the proposed sympathetic pathway in comatose patients. The preservation of central TCD oscillations argues in favor of different pathways and/or generators of cerebral and peripheral B- and M-waves. [Neurol Res 1999; 21: 665-669]     

卒中急性期血压的变化规律及影响因素研究

目的观察卒中急性期的血压变化规律以及影响血压变化规律的因素。方法研究入院距发病时间〈24h的急性脑梗死及脑出血的住院病人,进行基本数据收集,监测入院后7d内血压变化,对病程中伴发疾病进行评分,对入院后血压管理的方式及干预时间进行登记。结果（1）卒中急性期初期血压通常升高,入院后16h内血压下降较明显,前4h尤甚,16～48h血压逐渐平稳,各时点血压经方差分析无显著性差异;（2）脑出血患者的急性期血压较脑梗死患者的急性期血压高,P〈0.05;（3）TOAST各亚型脑梗死血压变化规律无明显差异;（4）原有高血压史的患者卒中后急性期血压较既往无高血压史的患者高;（5）经多因素相关分析,影响卒中急性期7d内平均收缩压的正相关因素有卒中类型、高血压史、伴发病评分;影响卒中急性期7d内平均舒张压的正相关因素有卒中类型、高血压史、伴发病评分,既往病史评分与卒中急性期7d内平均舒张压呈负相关。结论卒中急性期初期血压通常升高,脑出血、既往有高血压史、合并疾病多的卒中患者卒中后血压较高,入院后16h内血压下降较明显,入院后16～48h血压渐趋平稳。     

经颅多普勒对颅内感染患者颅内压和脑灌注压的预测价值

目的 探讨经颅多普勒（TCD）频谱参数对颅内感染患者颅内压（ICP）和脑灌注压（CPP）的预测价值。方法 对42例颅内感染患者进行的128次腰穿测压前行TCD检查,对TCD资料及脑脊液压力进行分析,并与对照组比较。结果 颅内感染组患者随着ICP升高,TCD表现出高阻力血流频谱,波形普遍变尖,收缩期血流（Vs）无明显变化,舒张期血流（Vd）减慢,搏动指数（PI）增大。与对照组比较血流速度明显增快。根据TCD参数及预测ICP（ICPe）及预测CPP（CPPe）的回归方程,ICPe及CPPe值与实测的ICP、CPP值呈正相关（r=0．594、0．910,均P〈0．001）。结论 TCD频谱参数可较准确预测颅内感染患者ICP、CPP的变化。     

Nocturnal pulse wave attenuation is associated with office blood pressure in a population based cohort

Objective and BackgroundPulse wave amplitude (PWA) derived from the digital vascular bed has been used in sleep studies. The nocturnal attenuation of PWA has been shown to reflect sympathetic activation during sleep. We assessed the relationship between nocturnal PWA attenuation and office blood pressure (BP).MethodsEighty-one subjects (46 men; age 60 ± 7 years; body mass index [BMI] 28.2 ± 4.3 kg/m²; apnea hypopnea index [AHI], 25.4 ± 22.6 events/h; systolic BP 137 ± 15 mmHg; diastolic BP 79 ± 7 mmHg) recruited from a population based cohort underwent simultaneous ambulatory polysomnography (PSG) and peripheral arterial tonometry (PAT) recording. Episodic attenuations of PWA derived from the pulse waveform of the PAT signal were identified and characterized. Generalized least squares regression models were used to identify the associations between median PWA attenuation (PWA.att), office BP and sleep-related disordered breathing.ResultsWe found that the association between PWA.att and office BP was independent of gender, age, BMI, antihypertensive medication, number of attenuation episodes, AHI, oxygen desaturation ?4% index (ODI4) and arousal index. Each 10% increase in PWA.att was associated with increases of 5.0 mmHg systolic BP (P = 0.02) and 3.0 mmHg diastolic BP (P = 0.005). We also found independent relationships between systolic/diastolic BP and BMI (P = 0.0006/0.001), AHI (P = 0.03/0.1) and ODI4 (P = 0.03/0.03).ConclusionsThe degree of PWA attenuation during the night is associated with office BP independent of sleep-disordered breathing. Continuous assessment of PWA during sleep may provide novel insights into cardiovascular physiology and morbidity.     

599例健康人群脉搏波传导速度的测定及其相关危险因素分析

目的探讨影响健康人群上臂-踝间脉搏波传导速度(baPWV)的相关危险因素。方法选择我院常规体检的正常人群,测量各项指标,根据baPWV的结果进行分组,baPWV<1400cm/s为正常对照组,baPWV≥1400cm/s为无症状动脉硬化组,并对各组结果进行统计分析。结果无症状动脉硬化组年龄(Age)、血糖(Glu)、收缩压(SBP)、舒张压(DBP)、脉压(PP)、低密度脂蛋白(LDH)、颈动脉内-中膜厚度(IMT)及体重指数(BMI)显著高于正常对照组。将Age、甘油三酯(TG)、胆固醇(TC)、LDL、SBP、DBP、PP、IMT及BMI作为自变量,baPWV作为应变量,进行单变量Logistic回归,结果表明Age、Glu、SBP、DBP、PP、LDL、IMT和BMI是baPWV的影响因子。而多变量Logistic回归显示,Age、GLU、SBP及PP是baPWV的独立危险因素。结论随着Age、GLU、SBP、DBP、PP、LDL、IMT及BMI的增高,baPWV数值逐渐增大,Age、GLU、SBP及PP是baPWV的独立危险因素。     

脑梗死急性期血压与预后的相关研究

目的 研究脑梗死急性期血压变化与预后的关系,为临床血压管理提供依据.方法 采用前瞻性队列研究方法,连续登记2004年10月～2010年1月入住苏州大学附属第二医院神经内科及2004年10月～2006年8月入住苏州市立医院本部神经内科的发病24h内的脑梗死患者.连续观察入院7d内血压,记录随访6个月时死亡情况.对影响急性期预后的各因素进行Logist回归分析.结果 本研究共纳入480例脑梗死患者.入院时血压与预后呈L型关系,即当收缩压(SBP)<120mmHg,舒张压(DBP)<70mmHg时死亡率均明显升高.7d内平均SBP与预后呈U型关系(P<0.05),即当SBP在120～140mmHg之间预后最好,高于或低于此范围死亡率均升高.7d内连续性变异与死亡率呈正相关,变异率越大死亡率越高.24h内血压下降率与预后呈u型关系,下降率不超过20%时预后最好(P<0.05).影响预后的主要血压因素为血压的连续性变异率.结论 急性期血压独立影响脑梗死患者预后,入院7d内血压的处理应谨慎.