腔隙性脑梗死患者血压变异性与早期神经功能恶化的相关性研究

Relationship between blood pressure variability and early neurological deterioration in patients with lacunar cerebral infarction

目的分析腔隙性脑梗死患者血压变异性与早期神经功能恶化的相关性。方法选取2018年2月至2019年2月郑州人民医院收治的腔隙性脑梗死患者60例。入院7 d内发生脑梗死早期神经功能恶化患者为试验组,选取未发生脑梗死早期神经功能恶化腔隙性脑梗死患者为对照组,每组30例。连续监测试验组与对照组患者24 h血压变异的参数,分析比较两组高血压、冠心病、空腹血糖水平、发病至入院时间、平均舒张压、24h-DBP-CV、平均收缩压。结果试验组有高血压病史患者16例(53.33%,16/30),对照组有高血压病史患者18例(60.00%, 18/30),差异未见统计学意义(P>0.05);试验组有冠心病5例(16.67%,5/30),对照组有冠心病4例(13.33%,4/30),差异未见统计学意义(P>0.05)。试验组患者空腹血糖水平为(7.12±2.11) mmol/L,对照组患者空腹血糖水平为(6.76±2.02)mmol/L,两组比较差异有统计学意义(P<0.05)。试验组患者发病至入院时间为(11.21±1.22)h,对照组患者发病至入院时间为(10.09±1.10)h,差异未见统计学意义(P>0.05)。两组患者的平均舒张压比较,差异未见统计学意义(P>0.05)。试验组患者24h-DBP-CV为10.4,对照组患者的24h-DBP-CV为10.2,差异未见统计学意义(P>0.05)。对照组与试验组患者的24h-SBP-CV水平、平均收缩压等指标比较,差异有统计学意义(P<0.05)。结论腔隙性脑梗死患者早期神经功能恶化(END)的危险因素为入院后24 h收缩压变异较大,保持血压变异性小和血流动力学稳定能够有效避免患者神经功能恶化,具有临床推广意义。

Objective To analyze the relationship between blood pressure variability and early neurological deterioration in patients with lacunar cerebral infarction.Methods Sixty patients with lacunar cerebral infarction admitted to Zhengzhou People’s Hospital from February 2018 to February 2019 were selected. The patients with neurologic deterioration in early stage of cerebral infarction within 7 days after admission were selected as the experimental group, and the patients with lacunar cerebral infarction without neurologic deterioration in early stage of cerebral infarction were selected as the control group, with 30 cases in each group. The parameters of 24-h blood pressure variation in the experimental group and the control group were monitored continuously, and the levels of hypertension, coronary heart disease and fasting blood glucose in the two groups, the time from onset to admission, mean diastolic pressure, 24-DBP-CV and mean systolic pressure were analyzed and compared.Results There were 16 patients(53.33%, 16/30) with hypertension history in the experimental group, 18 patients(60.00%, 18/30) with hypertension history in the control group, the difference was not significant(P>0.05);there were 5 patients(16.67%, 5/30) with coronary heart disease in the experimental group, and 4 patients(13.33%, 4/30) with coronary heart disease in the control group, the difference was not significant(P>0.05). The fasting blood glucose level of the experimental group was(7.12 ± 2.11) mmol/L, and that of the control group was(6.76 ± 2.02) mmol/L, there was significant difference between the two groups(P<0.05). The time from onset to admission was(11.21±1.22) h in the experimental group and(10.09±1.10) h in the control group, respectively, with no significant difference(P>0.05). There was no significant difference in mean diastolic pressure between the two groups(P>0.05). The 24-DBP-CV of the experimental group was 10.4, and that of the control group was 10.2, there was no significant difference(P>0.05). There were significant differences in 24-hour SBP-CV level and mean systolic blood pressure between the control group and the experimental group(P<0.05).Conclusions The risk factor of early neurological deterioration(end) in patients with lacunar cerebral infarction is that systolic blood pressure varies greatly 24 hours after admission. Keeping blood pressure variability small and hemodynamic stability can effectively avoid the deterioration of neurological function, which has clinical significance.