老年脑岀血患者急性期血压及其与1月预后的关系

A study on the relationship between blood pressure level and prognosis in aged patients with acute hemorrhage

目的探讨老年脑出血急性期血压特征及其与近期预后的关系。方法采用前瞻性队列研究方法,连续登记2008年1月～2011年6月入院老年脑岀血患者。连续记录入院后7 d血压,在发病1月时评价预后,比较不同预后组入院急性期7 d内特征,并比较入院时和1个月时的改良Rankin量表评分(Modifi-cation of Rankin Scale,MRS)、美国国立卫生研究所脑出血评分(National Institute of Health Stroke Scale,NIHSS),并对数据进行分析。结果急性期7 d内平均收缩压与1月预后差呈U型关系,按不同平均收缩压亚组,平均收缩压在160～179 mmHg之间预后较好,MRS评分、NIHSS评分较低,相应1月改善显著;平均舒张压亚组与1月预后差之间这种U型效应消失,舒张压高,大于100 mmHg提示预后差,入院时不同舒张压亚组MRS和NIHSS评分差异不明显(P>0.05),MRS和NIHSS评分1月改善比较其差异显著(P<0.05)。结论老年脑岀血患者急性期7 d内平均收缩压在160～179 mmHg之间预后较好;急性期平均舒张压不能反映预测病情严重程度,但可反映预后转归倾向。

Objective To investigate the relationship between the mean level of blood pressure in acute phase of aged-patient with acute hemorrhage and its prognosis. Methods Consecutive aged-patients after acute hemorrhage onset in the ward of Department of Neurology,1st hospital of Changsha were analyzed using prospective array method from January 2008 to June 2010.Their average blood pressure at the first seven days after admission were recorded.Their scores of Modification of Rankin Scale（MRS） and National Institute of Health Stroke Scale（NIHSS） at admission and discharge and days of hospitalization were also recorded,respectively. Results 275 aged-patients were included.A U-shaped relationship was found between mean systolic BP and prognosis.The patient who had a mean systolic BP of 160～179 mmHg in the first seven days after admission,would have a better prognosis.And their scores of Modification of Rankin Scale（MRS） and National Institute of Health Stroke Scale （NIHSS） at admission are lower than other groups.There isn＇t a U-shaped relationship between mean diastolic BP and prognosis.The patients who had a mean diastolic BP of over 100 mmHg in the acute phase had a worse prognosis.Their scores of MRS and NIHSS at admission haven＇t significant disparations among different diastolic BP groups,respectively.While the improved scores of MRS and NIHSS at one month after stroke have significant disparations. Conclusions The aged-patient who had a mean systolic BP of 160～179 mmHg in the first seven days after admission,would have a better prognosis.The mean diastolic BP in acute phase cann＇t reflect severity of acute stroke.But a high level of man diastolic BP may be a tendency of a worse prognosis.