卒中急性期血压的变化规律及影响因素研究

Study of blood pressure variation and related independent factors in patients with acute stroke

目的观察卒中急性期的血压变化规律以及影响血压变化规律的因素。方法研究入院距发病时间<24h的急性脑梗死及脑出血的住院病人,进行基本数据收集,监测入院后7d内血压变化,对病程中伴发疾病进行评分,对入院后血压管理的方式及干预时间进行登记。结果(1)卒中急性期初期血压通常升高,入院后16h内血压下降较明显,前4h尤甚,16～48h血压逐渐平稳,各时点血压经方差分析无显著性差异;(2)脑出血患者的急性期血压较脑梗死患者的急性期血压高,P<0.05;(3)TOAST各亚型脑梗死血压变化规律无明显差异;(4)原有高血压史的患者卒中后急性期血压较既往无高血压史的患者高;(5)经多因素相关分析,影响卒中急性期7d内平均收缩压的正相关因素有卒中类型、高血压史、伴发病评分;影响卒中急性期7d内平均舒张压的正相关因素有卒中类型、高血压史、伴发病评分,既往病史评分与卒中急性期7d内平均舒张压呈负相关。结论卒中急性期初期血压通常升高,脑出血、既往有高血压史、合并疾病多的卒中患者卒中后血压较高,入院后16h内血压下降较明显,入院后16～48h血压渐趋平稳。

Objective To explore the blood pressure variation and influential factors in patients with acute stroke. Methods 342 consecutive inpatients admitted within the first 24 hours after the onset of stroke were studied, and the basic information were collected, the blood pressure values were monitored during the first 7 hospital days, graded the companion diseases, recorded the ways and the time of managing blood pressure. The data was analyzed with SAS statistic software. Results （1） Blood pressure elevated in initial stage of acute stroke, it distinctively decreased during the first 16 hours, especially infirst 4 hours, and changed smoothly from 16 hours to 48 hours after admission, P 〈 0.05. （2） Blood pressure in acute stage of brain infarction was higher than that of cerebral hemorrhage. （3） Blood pressure of stroke patients was higher than that of patients without hypertension, history in acute stage. （4） Blood pressure variation had no difference among five brain infarction subgroups. （5）Multiple linear regression analysis revealed that stroke type, history of hypertension and scores of companion diseases were positively related with mean blood pressure , while scores of anamnesis were negatively related with mean diastolic blood pressure （DBP） in patients with acute stroke. Conclusions Blood pressure usually elevate in patients with acute stroke, it decrease distinctively during the first 16 hours, and change smoothly from 16 hours to 48 hours after admission. Blood pressure is higher in those patients who are cerebral hemorrhage, who had hypertension previously and more companion diseases than others at acute stage of stroke.