脑梗死患者急性期血压监测与预后的初步研究

目的探讨脑梗死患者急性期动态血压的变化及血压与预后的相关性。方法本研究为前瞻性地对发病48h内入院的53例脑梗死患者进行24 h动态血压监测,持续10天,记录其他影响预后的危险因素,并在21天、3个月做近远期神经功能评分。结果脑梗死患者急性期高血压常见,有自发下降的趋势。在入院4天时,收缩压和舒张压分别下降(8.8±7.9)mm Hg(、4.5±5.0)mm Hg(1 mm Hg=0.133 kPa,P<0.05),4~10天时血压下降趋势趋于平缓。脑梗死患者急性期血压与远期预后单因素分析显示呈U型曲线关系,血压的最适水平为收缩压140~160mm Hg,舒张压75~80 mm Hg。但在多因素分析中仅收缩压≥160 mm Hg与140~159.9 mm Hg比较是近期(P=0.024)和远期(P=0.046)预后不良的独立危险因素,收缩压每升高10 mm Hg,近期和远期预后不良的危险性分别增加368.2%和137.2%。结论脑梗死患者急性期血压显著升高(收缩压≥160 mm Hg)提示预后不良。

A pilot study of ambulatory blood pressure monitoring and its prognostic value in acute ischemic stroke

Objective To evaluate blood pressure changes in the acute phase of cerebral infarction and the relationship between BP and early or late neurological outcome.Methods Fifty-three patients admitted within 48 hours of stroke onset were studied prospectively.Blood pressures were collected by monitoring for 10 days.The other prognostic factors were recorded through detailed investigation.The early and late outcomes were assessed 21 days and 3 months after stroke onset and were defined as modified ranking scale score ≥3.Results The elevated blood pressure after acute ischemic stroke declined spontaneously.After 4 days SBP and DBP declined by(8.8±7.9) mm Hg/(4.5±5.0) mm Hg(P<0.05).From the 4th to 10th day,BP still declined slightly though not significantly.A u-shaped relationship was observed between blood pressure and late outcome in acute ischemic stroke.The blood pressure level for the lowest frequency of poor outcome was 140～160 mm Hg(SBP) and 75～80 mm Hg(DBP).However,after adjusting other prognostic factors,only SBP≥160 mm Hg showed a significant relationship with poor outcome in logistic regression.For every 10mmHg above 160 mm Hg,the risk of early and late poor outcome increased by 368.2% and 137.2%.Conclusions Elevated blood pressure was common in acute ischemic stroke.However it declined spontaneously 4 to 10 days after stroke.A significantly elevated blood pressure(SBP≥160 mm Hg) usually indicates a poor neurological outcome.