高血压性脑出血病人收缩压与不良预后的关系

目的 探讨高血压性脑出血病人收缩压（SBP）与预后、血肿扩张及心肾不良事件的关系。方法 回顾性分析2015年10月至2018年10月收治的550例高血压性脑出血的临床资料。入院24 h内静脉注射盐酸乌拉地尔进行降血压治疗，采用无创24 h动态心电监护仪监测SBP，根据平均每小时SBP值为分5组（<125、125~135、135~145、145~155、≥155 mmHg），根据平均每小时最低SBP分为5组（<120、120~130、130~140、140~150、≥150 mmHg）；采用CT评估血肿扩张；心肾不良事件为治疗后7 d内发生心脏和肾脏并发症；采用电话随访方式收集出院90 d生存状态。采用多因素logistic回归分析检验SBP与不良事件的关系。结果 平均每小时SBP>155 mmHg与发病90 d内死亡（OR=1.38；95% CI 1.07~3.04）和血肿扩张（OR=1.13；95% 1.02~1.28）风险呈正相关。平均每小时最低SBP≥150 mmHg病人发病90 d内死亡风险升高（P<0.05）；平均每小时最低SBP≥140 mmHg时血肿扩张风险较高（P<0.05）。平均每小时最低SBP降低幅度越大，血肿扩张风险、发病90 d内死亡风险越低（P<0.05），但心肾严重不良事件呈明显增高（P<0.05）。结论 高血压性脑出血病人发病24 h平均每小时最低SBP降低幅度越大，血肿扩张和发病90 d内死亡风险越低，但心肾不良事件风险明显增加。

Relationship between systolic blood pressure and poor prognosis in patients with hypertensive intracerebral hemorrhage

Objective To explore the relationship of systolic blood pressure (SBP) with clinical outcomes in the patients with acute hypertensive intracerebral hemorrhage. Methods The clinical data of 550 patients with acute hypertensive intracerebral hemorrhage, who were treated in our department from October, 2015 to October, 2018, were analyzed retrospectively. The changes in SBP and the volumes of brain hematomas were monitored respectively by 24-hour dynamic ECG and CT imaging and the adverse cardiac and renal events and survival status 90 days after the discharge from the hospital were observed in all the patients. The relationship of SBP with the adverse events were analyzed by logistic regression analysis. Results The change in hourly average SBP over 155 mmHg was positively related with hematoma expansion and death in all the patients [OR (95% CI) was 1.38 (1.07, 3.04) and 1.13 (1.02, 1.28) respectively]. The death risk increased in the patients with the hourly average minimum SBP ≥150 mmHg. The higher hematoma expansion risk was observed in the patients with an average hourly minimum SBP ≥140 mmHg. The hypertensive hemorrhage patients with hourly average minimum SBP reduction of 60 mmHg or more than 60 mmHg had a decrease in the risk of hematoma expansion, and the hematoma expansion risk trended to a decrease with the decrease in the hourly average minimum SBP (Ptrend<0.05). In addition, the risk of cardio-renal adverse events trended to an increase and death risk trended to a decrease with the increase in hourly average minimum SBP reduction. Conclusion The present results suggests that the risks of hematoma expansion and death decrease and the risks of cardio-renal adverse events increase with the hourly average minimum SBP reduction in the patient with acute hypertensive intacerebral hemorrhage.