急性脑出血合并高血压病患者90d预后相关危险因素分析

The analysis of related risk factors of 90-day clinical outcomes in cerebral hemorrhage patients with hypertension

目的探讨急性脑出血患者90 d临床预后的相关危险因素,并分析脑出血最初24 h血压变异性与预后的关系。方法选取徐州市中心医院神经内科2013年10月~2016年1月收治6 h内入院的高血压性脑出血患者124例。用mRS(modified Rankin Scale)量表表示患者90 d临床预后,0~1分判定预后良好组及2~6分为预后不良组,分别记录入院后24 h内不同时间段的的收缩压和舒张压(32次血压值),用血压标准差(SD)、变异系数(CV)及最大-最小差值(Max-Min)来表示血压波动性(BPV)。用多因素logistic回归分析血压波动性与患者90 d临床预后的关系。结果 (1)2组基线水平(年龄、性别、血肿体积、入院神经功能评分如GCS,NIHSS)无明显差异(P>0.05),2组血压波动性有明显差异(P<0.05);(2)spearman相关分析显示收缩压的BPV(SD、CV、Max-Min)与90 d临床预后呈正相关,其相关系数分别为0.188,0.35,0.272,P均<0.05;(3)多因素Logisitic回归分析显示收缩压及舒张压的SD、CV、Max-Min与90 d临床预后有关,其中收缩压OR分别为5.12,3.477,5.12,P均<0.01;舒张压OR分别为1.35,2.24,1.04,P均<0.05。结论急性高血压性脑出血患者的最初24 h收缩压的血压波动性是影响90 d临床预后的重要因素,早期平稳降压有利于临床预后。

Objective To analyze the related risk factors of 90-day clinical outcomes in cerebral hemorrhage patients with hypertension and to evaluate the relation between blood pressure （BP） variability and the 90 days clinical outcome.Methods 124 acute spontaneous ICH patients were identified and enrolled in Xuzhou Central Hospital from October 2013 to 2016 January for within 6 hours from the onset of symptoms. The measurement of outcome was the 90 days functional status assessed by the modified Rankin Scale following a baseline severity-adjusted analysis.The primary outcome was death or major disability at 90th day （modified Rankin Scale score 2） and the secondary outcome was an ordinal shift in modified Rankin Scale scores at 90th day.BP measurements over the first 24 hours after admission were recorded（total 32）, and standard deviation （SD）, coefficient of variation （CV）, maximum minimum difference （Max-Min） were determined to characterize both systolic and diastolic BP variability （BPV）. Estimated associations between blood pressure variability and outcomes were analyzed by logistic and proportional odds regression models in this study.Results Among the 124 enrolled patients with ICH, there is a statistically significant difference in blood pressure variability of two groups （P〈0.05）.In the Spearman correlation analysis, only the systolic blood pressure of guideline-recommended group BPV （SD, CV, MAX-MIN） was positively related to clinical outcomes （r=0.188, 0.35, 0.272, P〈0.05）.A dose response relationship with a poor outcome was found for each measure of systolic BPV-adjusted odd ratios （ORs） for the highest third of SD,CV,Max-Min（OR=5.12,3.477,5.12,P〈0.01）. The strength of association with diastolic BPV turned out to be weaker and significant only for the higher values （adjusted ORs for the highest thirds of SD,CV,Max-Min：1.35,2.24,1.04,P〈0.05）.Conclusion In patients, Baseline characteristics of patients with acute ICH were similar between groups,BPV was a strong predictor of 90 days clinical outcome and might represent a still neglected potential therapeutic target. The benefits of early treatment to reduce blood pressure might be improved by smooth and sustained control, and particularly by avoiding peaks in systolic blood pressure.