短时血压变异性与非心源性栓塞性缺血性卒中患者早期转归的相关性分析

Correlation between short-term blood pressure variability and early outcome in patients with non-cardiac embolic cerebral ischemic stroke

目的探讨非心源性栓塞致缺血性卒中(CIS)患者的短时血压变异性与患者临床早期转归的相关性。方法选取于2015年3月-2018年7月延安大学附属医院神经内科住院治疗的非心源性栓塞性CIS患者120例,采集所有患者的一般资料和临床资料,监测所有患者的24h动态血压并计算患者的血压变异性指数,使用改良Rankin量表评价所有患者的近期神经功能转归,根据所有患者的改良Rankin量表评分进行分组,甲组患者98例,乙组患者62例。采用多变量Logistic方法分析患者短时血压变异性和患者临床转归的相关性。结果乙组患者的年龄、高血压发生情况、是否合并感染和急性期服用降压药以及患者的NIHSS评分明显高于甲组患者,差异有统计学意义(t/X2=-2.014、4.255、30.754、15.190、-10.345,P<0.05)。甲乙两组患者相比,甲组患者收缩压和舒张压的平均值、最大最小值、连续变异性参数和连续变异性参数最大值与乙组患者相比,差异均有统计学意义(P<0.05)。两组患者的昼夜血压节律日间平均动脉压和夜间平均动脉压相比,差异有统计学意义(P<0.05)。平均收缩压、年龄、基线NIHSS评分、患者合并感染和连续变异性参数均为与患者近期转归不良相关的独立危险因素,差异有统计学意义(P<0.05)。结论急性期非心源性CIS患者的短时血压变异性与患者的近期功能转归不良呈明显相关。

Objective To investigate the correlation between short-term blood pressure variability and early clinical outcomes in patients with cerebral ischemic stroke(CIS)without non-cardiac embolization.Method A total of 120 patients with CIS who underwent non-cardiac embolization from March 2015 to July 2018 in our hospital were enrolled.General data and clinical data of all patients were collected.All patients were monitored for 24 h ambulatory blood pressure.The patient’s blood pressure variability index was calculated,and the recent neurological outcomes of all patients were evaluated using the modified Rankin scale.Grouped according to the modified Rankin scale scores of all patients,98 patients in group A and 62 patients in group B.The multivariate Logistic method was used to analyze the correlation between short-term blood pressure variability and clinical outcomes.Results The age of patients in group B,the incidence of hypertension,whether or not to take the infection and the acute phase taking antihypertensive drugs,and the NIHSS score of patients were significantly higher than those in group A(t/x^2=-2.014,4.255,30.754,15.190,-10.345,P<0.05).The mean,maximum and minimum values of systolic and diastolic blood pressure,and the maximum values of continuous variability parameters and continuous variability parameters in group A were significantly different from those in group B(P<0.05).There was a statistically significant difference between the two groups of patients with circadian blood pressure rhythm between daytime mean arterial pressure and nocturnal mean arterial pressure(P<0.05).Mean systolic blood pressure,age,baseline NIHSS score,patients with co-infection and continuous variability were independent risk factors associated with poor outcomes(P<0.05).Conclusion The short-term blood pressure variability in patients with acute noncardiac CIS is significantly associated with poor functional outcomes in patients.