缺血性脑卒中患者急性期血压最大值与预后关系的研究

目的 探讨缺血性脑卒中入院后血压最大值与出院预后的关系.方法 2014年2－12月在哈尔滨医科大学附属二院神经内科病房采用队列研究方法连续收集471例缺血性脑卒中患者,跟踪测量其入院6 d的血压值.取每例患者6 d血压最大值作为血压水平的指标,将患者出院时生活自理能力Rankin评分量表(mRs)评分作为评判预后结局的指标.数据分析采用χ²、t检验和多因素非条件logistic回归分析.结果 以SBP最大值140～159 mmHg(1 mmHg=0.133 kPa)为基准,调整年龄、性别、文化程度、体力活动、人均月收入、吸烟、饮酒、高血压史、糖尿病史、冠心病史、脑卒中史、入院mRs评分、血脂异常、同型半胱氨酸和血糖后,SBP达到的最大值越大,患者出院不良预后的风险越大,SBP最大值为160～179 mmHg的OR值(95%CI)=2.51(1.30～4.85),SBP最大值> 180 mmHg的OR值(95%CI)=2.68(1.27～5.65).以DBP最大值90～99 mmHg为基准,调整多因素后发现DBP达到最大值越大,患者出现预后不良的风险增加,DBP最大值为100～109 mmHg的OR值(95%CI)=1.92(1.00～3.67),最大值> 110 mmHg的OR值(95%CI)=2.78(1.35～5.69).结论 缺血性脑卒中患者入院后血压达到最大值与出院不良预后有关.

Effect of maximum blood pressure when discharged from the hospital on the prognosis among patients with acute ischemic stroke

Objective To investigate the relationship between maximum blood pressure and the prognosis after discharged from the hospital,among patients with ischemic stroke. Methods A cohort study was conducted which including 471 cases of ischemic stroke patients that were collected from February 2014 to December 2014 at the Second Affiliated Hospital of Harbin Medical University. Values of everyday blood pressure were measured on each patient at the first six days after admitted to the hospital. Maximum blood pressure value of the 6 days was taken as an indicator of the blood pressure levels. The ability on daily living was measured by the modified Rankin score(mRs). Data were analyzed by Chi-square test,t test and multivariate logistic regression analysis. Results Confounding factors would include age,gender,culture,physical activity,income,smoking,alcohol,hypertension,diabetes,coronary heart disease,stroke history,hospitalization mRs,lipid parameters,homocysteine and blood sugar and were adjusted. Results from multivariate logistic regression analysis showed that the maximum SBP was associated with adverse outcomes. Compared with 140-159 mmHg for SBP,OR(95%CI) was 2.51(1.30-4.85) for 160-179 mmHg,OR(95%CI) was 2.68(1.27-5.65) for those pressure levels higher than 180 mmHg,after multiple factors were adjusted. Compared with 90-99 mmHg for DBP,OR(95%CI) was 1.92(1.00-3.67) for 100-109 mmHg,OR (95%CI) was 2.78(1.35-5.69) for the ones higher than 110 mmHg. Conclusion Maximum blood pressure during hospitalization might be associated with adverse outcome of ischemic stroke patients.