脑梗死急性期降压治疗与14天预后关系的研究

目的观察脑梗死急性期患者血压变化规律,探讨脑梗死急性期降压治疗与14 d预后的关系,为脑梗死急性期血压管理提供临床依据。方法将入选的143例急性脑梗死患者随机分为干预组70例和对照组73例。干预组给予降压治疗,使其1 d内收缩压下降10%～20%,入院7 d时血压降至140/90 mm Hg(1 mm Hg=0.133 kPa)以下,入院14 d内血压稳定在上述水平。动态监测2组患者14 d内的血压变化,采用美国卫生研究院卒中量表(NIHSS),观察2组患者入院时、14 d神经功能缺损程度及死亡/残疾比率。结果 2组入院14 d NIHSS评分呈降低趋势。与对照组比较,干预组患者14 d NIHSS评分、死亡/残疾比率明显降低(P<0.05)。多因素logistic回归分析显示,在调整了年龄、性别、高血压、入院NIHSS评分、入院血压及1 d血压下降幅度等因素后,降压治疗独立影响急性脑梗死14 d预后,降低14 d死亡/残疾的风险(OR=0.338,95%CI:0.136～0.840,P<0.05)。结论脑梗死急性期给予合理降压干预,有利于早期神经功能恢复,可降低14 d死亡/致残的风险。

Relationship between antihypertension treatment and early prognosis in patients with acute ischemic stroke

Objective To explore the relationship between antihypertension and prognosis in patients with acute cerebral infarction and provide guidance for clinical treatment.Methods 143 cases of patients with acute ischemic stroke were randomly divided into blood pressure intervention group and control group.Antihypertensive therapy was given to the intervention group.Treatment was targeted to a 10%to 20%systolic blood pressure reduction within l-daybut SBP≥120 mm Hg(l mm Hg = 0.133 kPa),DBP≥80 mm Hg],the first 7-day blood pressure in hospital should be decreased below 140/90 mm Hg,within 14 days the blood pressure should be kept at this level.Blood pressures were monitored from day to 14 of admission.The neurological impairment at 14 days(NIHSS) of the two groups of in patients,and the ratio of death/disability were observed.Results The 14-day NIHSS scores of the two groups were declined,but the neurological function of intervention group was improved more significantly,compared with the control group.The 14-day NIHSS scores and the ratio of risk of death to disability in intervention group were significantly lower than those of the control group(P<0.05).By using multiple logistic regression analysis adjusted for age,sex,history of hypertension,NIHSS scores after admission and so on,antihypertensive therapy in acute phase independently influenced 14 days prognosis of patients with cerebral infarction and reduced the risk of death/disability.Conclusions Reasonable blood pressure intervention in acute cerebral infarction was beneficial to the early recovery of neurological function and may reduce the 14-day risk of death/disability.