脑卒中急性期血压监测与预后相关性的初步研究

A Pilot Study of Ambulatory Blood Pressure Monitoring and Its Association with Outcome in Acute Stroke

目的探讨脑卒中急性期动态血压的变化及血压与预后的相关性。方法本研究分别对发病48 h内入院的53例脑梗死和38例脑出血患者进行24 h动态血压监测,持续10 d,并记录其他影响预后的危险因素及21 d、3个月的神经功能评分。结果脑卒中急性期血压升高的发生率为74．7%,入院4 d内血压下降显著,4～10 d时血压下降趋于平缓。多因素Logistic回归分析显示,脑卒中急性期收缩压升高是近期预后不良(OR=1．071,1．018～1．127,P =0．008)及远期(OR=1．040,1．010～1．071,P=0．009)预后不良(MRS≥3)的危险因素,对近期死亡无明显影响(OR=0．988,0．920～1．062,P=0．750)。亚组分析结果显示:脑梗死患者急性期血压与近、远期预后呈U型曲线关系,最适血压水平:收缩压140～160 mm Hg、舒张压75～80 mm Hg。经调整其他预测因子,收缩压≥160 mm Hg与140～159 mm Hg相比是近期(多因素Logistic回归分析,OR=4．682,1．23～17．823,P=0．024)和远期(OR=2．372, 1．188～4．735,P=0．014)预后不良的独立危险因素;脑出血患者急性期血压升高是近期死亡(多因素Logistic回归分析,OR=1．212 1．019～1．442 P=0．03)及远期(OR=1．27 1．019～1．583 P=0．033)预后不良的独立危险因素。结论脑卒中急性期血压升高常见,但血压有自调下降的趋势;脑梗死患者急性期收缩压≥160 mm Hg与预后不良呈显著相关,脑出血急性期血压升高是预后不良的独立危险因素。

Objective To evaluate blood pressure (BP) changes and the relationship between various BP variables in the acute phase of stroke and early or late neurological outcome.Methods We studied 91 patients (ischemic stroke,n=53; intracerebral hemorrhage,n=38) admitted within 48 h after stroke onset.BP values were collected by ambulatory monitoring tor 10 d.The other prognostic factors for outcome were recorded at admission.The early and late outcome was assessed 21 d and 3 months respectively after stroke onset Poor outcome was defined as modified Rankin Score (MRS)≥3.Results The frequency of elevated BP was 74.7% at acute phase of stroke.BP declined spontaneously and significantly within 4d after admission,and BP declined slightly from 4d to 10d.For all stroke patients,logistic regression showed that elevated SBP at acute phase was prog- nostic factor for early (OR=1.071,1.018～1.127,P=0.008) and late (OR=1.040,1.010～1.071,P=0.009) poor outcome.For ischemic stroke,a U-shaped relationship was observed between BP and late outcome.The BP level for lowest frequency of poor outcome was 140～160 mm Hg (SBP) and 75～80 mm Hg (DBP).After adjusting other prognostic factors, only SBP≥160 mm Hg showed a significant relationship with early ((OR=4.682,1.23～17.823,P=0.024) and late (OR =2.372,1.188～4.735,P=0.014) poor outcome in logistic regression compared with BP140～159 mm Hg.For intracere- bral hemorrhage,the high mean arterial pressure (MAP) at acute stage was prognostic factor for mortality at 21 d (OR=1.212, 1.019～1.442,P=0.03) and poor outcome at 3 months (OR=1.27,1.019～1.583,P=0.033).Conclusions Elevated BP is common in acute stroke.Usually it declines spontaneously early after stroke.SBP≥160 mm Hg for all stroke patients and MAP for intracerebral hemorrhage at acute stage of stroke may be prognosis factors for early and late pour outcomes.