脑分水岭梗死急性期血压与预后相关性研究

Association between Blood Pressure and the Prognosis in Acute Cerebral Watershed Infarction

目的探究脑分水岭梗死（cerebral watershed infarction,CWI）患者急性期血压与病情转归的关系。方法连续纳入发病48 h内入院的脑分水岭梗死患者。对入选患者进行血压监测,记录入院后前3 d血压,收集患者基本资料、卒中危险因素及辅助检查结果。出院3个月时随访评估改良的Rankin量表（modified Rankin scale,m Rs）作为预后评价。结果本研究总共纳入脑分水岭梗死患者110例,完成随访106例。收缩压以间距10 mm Hg分组后分析显示脑分水岭梗死患者急性期收缩压与预后呈U型曲线关系。收缩压最适水平在150∽160 mm Hg。在调整其他预后相关因素后,多因素logistic分析显示,当收缩压〈150 mm Hg时,收缩压每降低10 mm Hg,预后不良的危险率增加73.3%[比值比（odds ratio,OR）1.733,95%可信区间（confidence interval,CI）1.073∽2.799,P=0.024];当收缩压≥160 mm Hg时,收缩压与预后无明显相关。结论脑分水岭梗死急性期血压偏低提示预后不良,收缩压150∽160 mm Hg可能为最适血压。

Objective To evaluate the relationship between patients’ blood pressure in the acute phase of cerebral watershed infarction and their outcomes. Methods In this study, a consecutive series of patients hospitalized for cerebral watershed infarction within 48 hours of onset were enrolled. Blood pressures were measured for each patient from admission to the third day. All clinical datas included basic information, stroke risk factors and supporting test results were collected. At 3 months after stroke onset, the late outcomes were measured by the modiifed Rankin score （mRs）. Results A total of 106 patients were brought into the research. After grouped by the systolic blood pressure （SBP）, a u-shaped relationship was observed between blood pressure and late outcome. The optimal level of SBP was 150-160mmHg. After adjusted for other prognostic factors, multiple logistic regression analysis showed that, SBP declined every 10mmHg below 150mmHg, the risk of late poor outcome increased by 73.3% （OR=1.733, 95%CI 1.073-2.799,P=0.024）; when SBP≥160mmHg, SBP had no signiifcant relationship with poor outcome. Conclusion Low blood pressure in acute cerebral infarction watershed indicated a poor outcome, The optimal level of systolic blood pressure might be 150-160mmHg.