脑卒中急性期血压变化规律及影响因素的研究

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

目的 观察脑卒中急性期血压变化规律及其影响因素.方法 研究发病24h内入院的急性脑卒中患者704例.监测入院后7d内血压,收集详细病史资料,对病程中伴发疾病进行评分,记录入院后血压的管理方式及干预时间等.运用简单和多因素统计方法进行数据的统计分析.结果 脑卒中急性期血压升高,并且存在自发下降趋势,8h内下降最明显,36h趋于稳定.其中脑梗死患者血压在入院30h内趋于稳定,脑出血患者血压在入院96h内趋于稳定.出血性卒中患者血压要高于缺血性卒中患者.缺血性卒中患者TOAST分型和OCSP分型间血压无显著差异.神经功能缺损程度影响入院时和入院后36h内血压.独立影响入院时收缩压的因素有卒中类型、入院时NIHSS评分、心脏病史、高血压史,其中心脏病史与入院时血压成负相关.独立影响入院时舒张压的因素有卒中类型、年龄、入院NIHSS评分、高血压史.年龄与入院时舒张压呈负相关.独立影响7d内平均收缩压的因素有卒中类型、入院NIHSS评分、伴发疾病评分、心脏病史、高血压史、既往史评分.心脏病史与7d平均血压呈负相关.影响入院7d内舒张压的因素有卒中类型、年龄、伴发疾病评分、入院NIHSS评分、心脏病史.心脏病史和年龄与7d平均舒张压呈负相关.结论 脑卒中急性期血压升高,并有自发性下降趋势.卒中类型及高血压史与血压呈正相关,心脏病史及年龄与血压呈负相关.

Objective To explore the blood pressure changes and relevant factors in patients with acute stroke. Methods Total of 704 inpatients admitted within the first 24 hours after the onset of stroke was recruited. Their blood pressure level during the first 7 days was monitored, patients＇ general clinical data, and the companion disease information were collected and graded, and the time and treatment for managing blood pressure was recorded. Results Blood pressure was found elevated in initial stage of a- cute phase then decreased distinctively during the first eight hours. If gradually stablalized until 36 hours after admission. Patients with hemorrhagic stroke had significantly higher SBp and DBp than those with ischemic stroke. Neurologic impairment degree had co. rrelation with admission Bp and following Bp until 36 hour. Independent factors found related to admission SBp included stroke type, NIHSS score,the history of heart disease,and hypertension. Independent factors related to admission DBp were： stroke type, age,admitted NIHSS score, and hypertension. Conclusions Blood pressure usually elevated in patients with acute stroke,and decreased gradually. Independent factors related to admission Bp include stroke type, admitted NIHSS score, heart disease, and hypertension.