缺血性脑卒中患者急性高血压反应与脑卒中后认知功能障碍的相关性研究

Association between acute hypertensive response and post-stroke cognitive impairment in acute ischemic stroke patients

目的探讨首次缺血性脑卒中患者急性高血压反应(acute hypertensive response,AHR)与脑卒中后认知功能障碍(post-stroke cognitive impairment,PSCI)的相关性。方法连续纳入2015年1月~2017年12月在成都军区总医院神经内科住院的发病≤24h的首发急性缺血性脑卒中患者170例,根据AHR定义分为AHR组118例,非AHR组52例。根据患者简易智能状态检查量表(MMSE)评分分为PSCI组91例,非PSCI 79例。发病后3个月对患者进行认知功能评估。结果 AHR组认知功能障碍发生率明显高于非AHR组(64.4%vs 28.8%,P<0.01)。AHR组MMSE总分[(20.23±4.87)分vs(24.29±4.78)分,P=0.000]、即刻回忆[(1.97±0.80)分vs(2.69±0.61)分,P=0.000]、注意力和计算力[(3.02±1.57)分vs(3.60±1.62)分,P=0.030]、延迟回忆[(1.19±0.91)分vs(1.87±0.93)分,P=0.000]、视空间能力[(0.31±0.46)分vs(0.54±0.50)分,P=0.005]明显低于非AHR组。与非PSCI组比较,PSCI组收缩压、平均动脉压、脉压差、脑卒中后肺部感染、AHR发生率、AHR持续时间、改良Rankin量表评分明显升高,差异有统计学意义(P<0.05,P<0.01)。logistic回归分析显示,AHR为PSCI发生的独立危险因素(OR=3.835,95%CI:1.844~7.976,P=0.000)。结论 AHR是PSCI的危险因素,早期监测和干预可能改善脑卒中后患者的认知功能。

Objective To study the association between acute hypertensive response（AHR）and post-stroke cognitive impairment（PSCI）in first-ever acute ischemic stroke（AIS）patients.Methods One hundred and seventy AIS patients admitted to our hospital at≤24 hafter onset of AIS were divided into AHR group（n=118）and AHR-free group（n=52）according to the definition of AHR or into PSCI group（n=91）and PSCI-free group（n=79）according to their MMSE score.Their cognitive function was assessed at month 3 after onset of AIS.Results The incidence of cognitive impairment was significantly higher while the total MMSE score,immediate recall score,attention and calculation score,delayed memory score,and visual space score were significantly lower in ARH group than in ARH-free group（P〈0.05,P〈0.01）.The SBP,mean arterial pressure,pulse pressure and incidence of post-stroke pulmonary infection and ARH,duration of AHR and mRS score were significantly higher in PSCI group than in PSCI-free group（P〈0.05,P〈0.01）.Logistic regression analysis showed that AHR was an independent risk factor for PSCI（95%CI：1.844-7.976,P=0.000）.Conclusion AHR is a risk factor for PSCI.Early monitoring and intervention can improve the cognitive function of AIS patients.