老年卒中患者急性期血压变化及其与短期预后的关系

Relationship between blood pressure changes in acute phase of stroke and short-term prognosis in elderly patients

目的探讨老年卒中患者急性期血压变化特征及其与30 d预后的关系。方法采用前瞻性队列研究方法,连续登记2008年1月—2010年6月入院的老年卒中患者275例,其中脑梗死202例,脑出血73例。连续记录入院后7d的血压,在发病30d时评价预后。按照急性期7d内平均收缩压(120～139、140～159、160～179、180～199、>200 mm Hg)和舒张压(<69、70～79、80～89、90～99、>100 mm Hg)水平分别分为5个亚组,比较入院时和30 d时的改良Rankin量表评分(mRS)、美国国立卫生研究院卒中量表评分(NIHSS)。结果①275例患者中,有66例预后差,其中脑出血组22例,脑梗死组44例,两组比较差异无统计学意义(P=0.200)。两组急性期7 d内不同平均收缩压的30d预后差者的5个亚组预后比较,差异有统计学意义(P<0.05)。而急性期7 d内,不同平均舒张压水平的30d预后差者,5个亚组比较,除70～79mmHg与80～89mmHg两组间差异无统计学意义外(P>0.05),其余各亚组之间预后比较差异有统计学意义(P<0.05)。②平均收缩血压在160～179mmHg者,mRS(中位数2)和NIHSS(中位数7)评分较低,相应30d改善显著(mRS中位数差值为2,NIHSS中位数差值为4);平均舒张压>100 mmHg,提示预后差,mRS和NIHSS评分30d改善的比较,不同舒张压亚组两两比较,差异有统计学意义(P<0.05)。脑出血组平均舒张压在70～90mmHg范围内,往往预后较好;脑梗死组在70mm Hg以下者,预后最好。结论老年卒中患者急性期7 d内平均收缩压在160～179 mm Hg之间,30 d的预后较好;急性期平均舒张血压不能预测病情的严重程度,但可反映30 d预后转归的倾向。

Objective To investigate the relationship between the blood pressure changes in acute phase of stroke in elderly patients and its prognosis at day 30. Methods A total of 275 consecutive elderly patients with stroke were documented from January 2008 to June 2010 using a retrospective cohort study. Among them, 202 were cerebral infarction and 73 were intracerehral hemorrhage. Their blood pres- sures were continuously recorded at the first seven days. The prognosis of patients were evaluated at day 30 after onset of stroke. The patients were divided into 5 subgroups according to the mean systolic blood pressure （120- 139, 140 -159, 160- 179, 180 -199, and 〉 200 mm Hg） and the mean diastolic blood pressure （ 〈69, 70-79, 80-89, 90-99, and 〉100 mm Hg） within7 days in the acute phase of stroke. The modified Rankin scale （mRS） scores and the National Institute of Health Stroke Scale （NIHSS） scores at admission and at day 30 were compared. Results （1）Of the 275 patients, 66 had poor prognosis,among them 22 were in the intracerebral hemorrhage group and 44 in the cerebral infarction group. There was no significant difference between the two groups （P = 0. 200）. As for the mean systolic blood pressure in the acute phase （ within 7 days） for both groups and the different mean systolic blood pressures in 5 subgroups in patients with poor prognosis at day 30, there were significant difl＇erenees for their prognosis （ P 〈 0.05 ）. While the mean diastolic blood pressure within 7 days in the acute phase and the patients whose prognosis was poor, the prognostic comparison of the different mean diastolic blood pressures in all subgroups, except for 70 - 79 mm Hg and 80 - 89 mm Hg, there was no significant difference between the two groups （ P 〉 0. 05 ）. Comparing the prognosis, there were significant differences between all other groups （P 〈 0.05 ）. （2）When mean systolic blood pressure was 160 -179 mm Hg, the mRS scores （median 2） and NIHSS scores （ median 7） were lower and prognosis was better at day 30 （ mRS median score 2, NIHSS median score 7） ; When mean diastolic blood pressure was above 100 mm Hg, the prognosis was poor. There were significant differences in mRS and NIHSS scores at day 30 among the groups with differ- ent mean diastolic blood pressure （ P 〈 0. 05）. The mean diastolic blood pressure between 70 and 90 mm Hg in the intracerebral hemorrhage group often indicated a better prognosis. The prognosis was even better when mean diastolic blood pressure under the 70 mm Hg in the cerebral infarction group. Conclusion The prognosis of the elderly patients with stroke is better at day 30 within 7 days after onset of stroke if their mean systolic blood pressure between 160 and 179 mm Hg. The mean diastolic blood pressure in acute phase of stroke may not predict the severity of disease, but it may reflect the outeonle tendency of the patients at day 30.