脑梗死住院患者血压变异与出院预后关系分析

Impact the variability of blood pressure on the outcome of ischemic stroke patients upon discharge from the hospital

目的探讨脑梗死患者入院后血压变异与出院预后的关系。方法采用队列研究方法，于2012年3月至2013年3月连续收集哈尔滨医科大学附属第二医院神经内科脑梗死住院患者404例，记录患者入院时以及入院后连续5d的SBP和DBP，并计算每名患者6次血压测量值的变异系数（CV）作为入院后血压变异的指标[CV（SBP）和CV（DBP）]。对患者出院时进行mRs评分。数据分析采用Z检验、t检验和多因素非条件logistic回归模型。结果以CV（CBP）〈9为基准，调整年龄、性别、体力活动、吸烟、饮酒、BMI、心率、高血压史、糖尿病病史、脑卒中病史、入院时mRs评分、血脂异常、同型半胱氨酸以及血糖水平后，CV（DBP）≥9的脑梗死患者出院预后不良风险增加（OR=1．70，95％CI：1．02—2．84），CV（D（DBP）≥10与CV（DBP）〈10相比，aOR=1．86（95％CI：1．11～3．13）。CV（SBP）值增大未显示增加脑梗死出院预后不良的危险性。结论脑梗死患者入院时及入院后连续5d的血压变异增大与出院预后不良有关。

Objective To explore the relationship between blood pressure variability and worsening functional outcomes of patients upon discharge from the hospitals. Methods The study cohort consisted of 404 patients who presented to Second Affiliated Hospital of Harbin Medical University with ischemic stroke during March 2012-March 2013. Systolic BP and diastolic BP were measured for each patient from admission to the fifth day and coefficient of variation blood pressure calculated. Disability at discharge was measured by the modified Rankin score（mRs）. Chi-square test, t-test and multivariate logistic regression analysis were performed. Results After adjustment for potential confounding factors including age, sex, activity, smoking, alcohol intake, BMI, heart rate, hypertension, diabetes mellitus, stroke history, lipid parameters, homocysteine and FPG, results from the multivariate logistic regression analysis showed that when DBP variability was greater than 9, it was associated with a significantly worse functional outcome at hospital discharge compared with those less than 9, with the odds ratio as 1.70 （95%Ch 1.02-2.84）. When comparing the ones that DBP variability more than i0 with the ones less than 10, the odds ratio was 1.86 （95%CI： 1.11-3.13）. However, there was no significant association seen between SBP variability and the worse functional outcome at hospital discharge. Conclusion Blood pressure variability might be associated with ischemic stroke outcome at hospital discharge but needed more evidence to approve.