动脉粥样硬化型缺血性脑卒中急性期高血压的特点及控制水平对预后的影响

The characteristics of acute hypertension and the effect of control level on prognosis in patients with atherosclerotic ischemic stroke

目的探讨动脉粥样硬化型缺血性脑卒中急性期高血压的特点及控制水平对预后的影响。方法选择我院2014年11月~2015年11月收治的动脉粥样硬化型缺血性脑卒中急性期患者63例,将其按照随机数字法随机分为分为A组(n=33)和B组(n=30),A组不进行血压干预,B组进行血压干预,目标控制血压<140/90 mmHg,观察两组患者的血压变化及预后效果。结果 A组入院后12 h、入院后第1~8天SBP、DBP均显著高于B组(P<0.05),两组在入院后第9~14天SBP、DBP比较,差异无统计学意义(P>0.05);两组治疗3 d、7 d及14 d的NIHSS评分均显著低于入院时(t≥2.708,均P>0.05),两组不同时间点NIHSS比较、差异无统计学意义(t≤0.173,均P>0.05)。两组治疔14 d后的有效率分别为90.9%、90.%,两组有效率比较,差异无统计学意义(χ~2=0.015,P>0.05)。多因素Logistic回归模型分析显不入院血压24下降幅度,治疗后NIHSS评分为预后独立的危险因素(P<0.05)。结论动脉粥样硬化型缺血性脑卒中患者急性期进行血压控制无明显获益,影响其预后的主要危险因素是入院血压24 h下降幅度、入院NIHSS。

Objective To investigate the characteristics of acute hypertension and the effect of control level on the prognosis of atherosclerotic ischemic stroke. Methods A total of 63 patients with acute atherosclerotic ischemic stroke in our hospital from November 2014 to November 2015 were enrolled and divided into group A （n=33） and group B（n= 30） according to random number method. Blood pressure intervention was not carried out in group A, while that was carried out in group B. The target control blood pressure was〈140/90 mmHg, the changes of blood pressure and prog- nosis of the two groups were observed. Results The SBP and DBP of group A were significantly higher than those of group B at 12 hours after admission and from day 1 to day 8 after admission（P〈0.05）. There was no significant difference in SBP and DBP between two groups from day 9 to day 14 after admission（P〉0.05）. The NIHSS scores of the two groups on day 3, day 7 and day 14 were significantly lower than those at admission（t ≥2.708, all P〉0.05）. There was no significant difference in NIHSS between the two groups at different time points（t≤ 0.173, P〉0.05）. The effective rates of the two groups were 90.9% and 90.0%, respectively. And there was no significant difference between the two groups （X2= 0.015, P〉0.05）. Multivariate logistic regression analysis showed that the 24-hour reduction in blood pressure at admis- sion and NIHSS scores after treatment were independent risk factors for the prognosis（P〈0.05）. Conclusion There is nosignificant benefit through controlling blood pressure in acute period for patients with atherosclerotic ischemic stroke. The major risk factors for prognosis are the 24-hour reduction in blood pressure at admission and the NIHSS after treat- ment.