脑分水岭梗死急性期血压与预后相关性研究

目的 探究脑分水岭梗死 （cerebral watershed infarction， CWI） 患者急性期血压与病情转归的关系。方法 连续纳入发病48 h内入院的脑分水岭梗死患者。 对入选患者进行血压监测， 记录入院后前3 d血压， 收集患者基本资料、 卒中危险因素及辅助检查结果。 出院3个月时随访评估改良的Rankin量表（modified Rankin scale， mRs） 作为预后评价。结果 本研究总共纳入脑分水岭梗死患者110例， 完成随访106例。 收缩压以间距10 mmHg分组后分析显示脑分水岭梗死患者急性期收缩压与预后呈U型曲线关系。 收缩压最适水平在150～160 mmHg。在调整其他预后相关因素后， 多因素logistic分析显示， 当收缩压＜150 mmHg时， 收缩压每降低10 mmHg，预后不良的危险率增加73.3%[比值比 （odds ratio， OR ） 1.733， 95%可信区间 （confidence interval， CI ）1.073～2.799， P =0.024]； 当收缩压≥160 mmHg时， 收缩压与预后无明显相关。结论 脑分水岭梗死急性期血压偏低提示预后不良， 收缩压150～160 mmHg可能为最适血压。

Association between Blood Pressure and the Prognosis in Acute Cerebral WatershedInfarction

Objective To evaluate the relationship between patients’ blood pressure in the acute phase ofcerebral watershed infarction and their outcomes.Methods In this study, a consecutive series of patients hospitalized for cerebral watershedinfarction within 48 hours of onset were enrolled. Blood pressures were measured for each patientfrom admission to the third day. All clinical datas included basic information, stroke risk factorsand supporting test results were collected. At 3 months after stroke onset, the late outcomes weremeasured by the modified Rankin score (mRs).Results A total of 106 patients were brought into the research. After grouped by the systolic bloodpressure (SBP), a u-shaped relationship was observed between blood pressure and late outcome.The optimal level of SBP was 150-160 mmHg. After adjusted for other prognostic factors, multiplelogistic regression analysis showed that, SBP declined every 10 mmHg below 150 mmHg, therisk of late poor outcome increased by 73.3% ( OR =1.733, 95% CI 1.073-2.799, P =0.024); whenSBP≥160 mmHg, SBP had no significant relationship with poor outcome.Conclusion Low blood pressure in acute cerebral infarction watershed indicated a poor outcome,The optimal level of systolic blood pressure might be 150-160 mmHg.