血压与出血性脑梗死预后的关系探讨

Relationships between blood pressure and hemorrhagic cerebral infarction

目的 探讨血压与出血性脑梗死预后之间的关系.方法 回顾性分析242例急性脑梗死患者的临床资料,筛选出所有出血性脑梗死病例,比较不同血压水平（＞180/110 mm Hg;90/70～180/110 mm Hg;＜90/70 mm Hg）在出血性脑梗死患者中的分布差异.结果 所有急性脑梗死病例中,血压＜90/70 mm Hg患者10例（4.1%）,血压90/70～180/110 mm Hg患者213例（88.0%）,血压＞180/110 mm Hg患者19例（7.9%）.继发出血性脑梗死20例（8.3%）,其中血压＞180/110 mm Hg患者12例（60.0%）,死亡7例;血压＜90/70 mm Hg患者2例（10.0%）,死亡1例;血压90/70～180/110 mm Hg患者6例（30.0%）,死亡2例.两种脑梗死类型中血压＞180/110 mm Hg患者的分布差异具有统计学意义（P=0.000）,以出血性脑梗死病例比例较高;而在出血性脑梗死病例中,不同血压水平患者的预后差异分布亦具有统计学意义,血压＞180/110 mm Hg（P=0.041）及血压＜90/70 mm Hg（P=0.037）者病死率较高.结论 重度高血压（＞180/110 mm Hg）可能是出血性脑梗死发病的高危因素,病程中合并重度高血压（＞180/110 mm Hg）及低血压（＜90/70 mm Hg）的出血性脑梗死患者预后较差,合理的血压控制有助于改善其预后.

Objective To explore the relationship between blood pressure and hemorrhagic cerebral infarction. Methods Retrospectively reviewed clinical data of 242 patients with acute cerebral infarction, then all patients with hemorrhagic cerebral infarction were selected. The distributions of different level of blood pressure （〉180/110mm Hg;90/70～180/110mm Hg;〈90/70mm Hg） were compared between the patients with or without hemorrhagic cerebral infarction, as the same, different prognosis were compared among the patients with hemorrhagic cerebral infarction based on the different level of blood pressure. Results Of the total patients with acute cerebral infarction,4. 1%（10） presented with blood pressure〈90/70mm Hg,88. 0%（213） with blood pressure 90/70～180/110mm Hg and 7.9%（19） with blood pressure〉180/110mm Hg. In all the patients,20 cases（8. 3%） with hemorrhagic cerebral infarction,among which,60.0%（12） patients with blood pressure〉180/110mm Hg and with 7 cases died, 10.0%（2） patients with blood pressure〈90/70mm Hg and with 1 case died,30.0%（6） patients with blood pressure 90/70～180/110mm Hg and with 2 cases died. The distribution of patients with blood pressure〉180/110mm Hg in those two type of cerebral infraction were statistically significant （P=0. 000） ,the ratio seemed higher in patients with hemorrhagic cerebral infarction, and among the patients with hemorrhagic cerebral infarction, the distribution of prognosis were the same statistically significant based on the diffetent level of blood pressure, among which, patients with blood pressure〉180/110mm Hg（P =0.041） or〈90/70mm Hg（P =0.037） seemed like to have a higher mortality. Conclusion Severe high blood pressure（〉180/110mm Hg） should be one of the high risk factors for patients with hemorrhagic cerebral infarction,when blood pressure〉180/110 mm Hg or 〈90/70mm Hg happened in the pathogenesis, patients always be with poor outcome. So, making proper control strategy of blood pressure for patients with hemorrhagic cerebral infarction was with significance to defend its＇ happening and prognosis＇ improvement.