脑卒中急性期血压与预后的关系

Blood pressure and prognosis in patients with acute stroke

目的分析脑卒中急性期血压与预后的关系，为临床治疗和试验设计提供依据。方法采用前瞻性队列研究方法，连续登记2002年3月至2004年3月人院、发病24h内的脑卒中患者。连续观察人院后10d血压，随访1个月和6个月时死亡、残疾和复发情况。采用Logistic多因素逐步回归分析血压与预后关系。结果共纳入脑卒中患者592例。血压与预后呈U型关系。人院时血压在120／90mmHg左右、第1—7天每天的平均血压在140／90mmHg左右预后较好。独立影响1个月死亡的血压因素是24h内血压下降程度，独立影响6个月死亡／残疾的是第3—7天每天的平均血压。结论脑卒中患者急性期血压独立影响预后，人院7d内血压处理应谨慎。

Objective To explore the relationship between blood pressure （BP） and prognosis in patients with acute stroke. Methods Consecutive acute stroke patients in the ward of Department of Neurology, West China Hospital, Sichuan University were analyzed using prospective array method from March 2002 to March 2004. The mean BP was consecutively recorded from day 1 to day 10 of hospitalization. Death, disability （BI ≤ 60 ） and recurrence were followed up at 1 and 6 months after the ictus of stroke. Logistic regression model was used to estimate the relationship between BP and prognosis. Results 592 patients were included. A U-shaped relationship was found between BP and prognosis. Those who had a BP of 120/90 mm Hg on admission, 140/90 mm Hg on day 1-7 would have a better prognosis. The independent BP-related predictor of death at 1-month and death/disability at 6-month was the decrease of BP during the first 24 hours and the average BP on day 3-7 respectively. Conclusions BP in acute stage influcences independently the prognosis in patients with acute stroke, thus the blood pressure should be cautiously handled during the first 7-day hopitalization.