急性出血性脑卒中患者动态血压特征及与预后的关系
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(1.汕头大学医学院第一附属医院重症医学科,;4.汕头大学医学院第一附属医院神经损伤及脊髓外科,;5.汕头大学医学院第一附属医院血液净化科,广东省汕头市 515041;2.汕头大学医学院公共卫生与预防医学教研室,广东省汕头市 515041;3.吉林大学中日联谊医院护理部,吉林省长春市 130033)

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王园园,硕士,主管护师,研究方向为脑血管疾病的临床流行病学研究。

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广东省科技计划项目(2011B031800209,2013B021800264)


Relationship Between Ambulatory Blood Pressure Characteristics and Prognosis in Patients with Acute Hemorrhage Stroke
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Department of Intensive Care Unit, the First Affiliated Hospital of Shantou University, Shantou, Guangdong 515041, China)

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    摘要:

    目的 研究急性出血性脑卒中患者入院7天内动态血压变化规律以及血压变化对预后的影响。方法入选141例急性新发出血性脑卒中患者,连续监测患者7天的24 h 动态血压,采集每2 h奇数时点的血压值。收集患者相关临床资料,采用患者入院30天后的格拉斯哥预后评分(glasgow outcome scale,GOS) 判断预后,GOS评分4~5分记为预后好组,GOS评分1~3分记为预后差组。分析患者入院收缩压(SBP)和舒张压(DBP)、7天白天SBP和DBP均值、7天夜间SBP和DBP均值及7天昼夜节律变化等与患者预后的关系。结果 急性新发出血性脑卒中患者7天内24 h血压均呈逐渐下降的趋势,两组第7天24 h血压均值比第1天血压均值有明显的下降 (P<0.05),多因素分析显示入院24 h平均SBP高、入院格拉斯哥评分 (glasgow coma scale,GCS) 低、入院白细胞高、出血量多、基底节出血是出血性脑卒中患者近期不良预后的危险因素 (P<0.05)。结论 急性出血性脑卒中患者7天各种血压指标在预后差组中偏高。患者入院时病情严重,基底节出血量大,入院第1天的平均24 h SBP高对患者的近期不良预后影响较大,重视急性期24 h血压监测尤其是凌晨的血压变化,并积极控制患者的血压和出血量有利于改善患者的预后。

    Abstract:

    Aim To investigate the change of ambulatory blood pressure (BP) for 7 days after admission and its impact on the prognosis for patients with acute hemorrhage stroke. Methods 141 patients with new onset acute hemorrhage stroke were enrolled. The 7-day/24-hour (24 h) ambulatory BP was monitored and the odd points of time of BP were collected per two hours. Related clinical data of patients were collected. The prognosis of patients was determined according to the 30-day Glasgow outcome scale (GOS) after admission, and the relationships of prognosis and ambulatory BP changes such as admission systolic BP (SBP) and diastolic BP (DBP), 7-day daytime/nighttime mean SBP and DBP, 7-day BP circadian rhythm (BPCR) changes etc, were analyzed. Results 7-day/24-h mean BP decreased gradually among patients with new onset acute hemorrhage stroke. The BP on the seventh day was significantly lower than that on the first day (P<0.05). There was no significant difference in BPCR between two groups (P>0.05). There were significant difference between two groups in 7-day/24-h BP, admission Glasgow coma scale (GCS), white blood cells (WBC), hospital days, midline shift, broken into the ventricle, history of hypertension, and admission SBP(P<0.05). Multivariate logistic regression showed that admission high 24-h mean SBP, low admission GCS, high WBC, big amount of bleeding, basal ganglia hemorrhage were the risk factors for the poor prognosis of acute hemorrhage stroke (P<0.05). Conclusion 7-day/24-h BP was higher in the poor prognosis group among patients with new onset acute hemorrhage stroke, and admission severe disease, big basal ganglia hemorrhage, high admission 24-h SBP were indicators for the severity of condition and poor prognosis. Monitoring and control of admission 24-h SBP and the amount of bleeding are beneficial for improving the prognosis of acute hemorrhage stroke.

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王园园,张庆英,丁赞,田静,伍艳春,李艳操.急性出血性脑卒中患者动态血压特征及与预后的关系[J].中国动脉硬化杂志,2016,24(7):673~678.

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  • 收稿日期:2015-08-11
  • 最后修改日期:2015-10-29
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  • 在线发布日期: 2016-07-05