不同血压水平急性脑出血患者预后分析

Prognostic analysis of patients with acute cerebral hemorrhage at different blood pressure levels

目的通过对我院发病24h内的急性脑出血患者进行前瞻性研究,探讨血压水平与预后的关系,为脑出血患者治疗期间的血压控制提供参考。方法选择2015年1月~2018年1月在我院收治的急性脑出血患者158例为研究对象。患者入院后每小时测一次血压水平,计算24h内的平均动脉压(MAP),将患者分为三组:MAP≥140mm Hg为血压增高组;90mm Hg<MAP<140mm Hg为血压正常组;MAP≤90mm Hg为血压降低组。收集患者一般资料,随访30d患者预后并比较。结果三组患者年龄、入院24h GCS评分和血肿体积比较差异有统计学意义(P<0.05),两两比较显示,血压增高组的年龄和入院24h血肿体积高于血压正常组和血压降低组,血压增高组和血压降低组的入院24h GCS评分低于血压正常组,差异有统计学意义(P<0.05)。所有患者均完成随访。共有41人死亡,死亡率为25.95%,血压增高组的30d死亡率显著高于血压正常组(P<0.017)。改良Rankin量表(mRS)评估显示,血压正常组的预后均显著优于血压增高组和血压降低组(P<0.017)。K-M法生存分析显示,血压正常组的生存率显著高于血压增高组和血压降低组。结论对于急性脑出血患者积极控制MAP在90~140mm Hg,可以减少继续出血风险,减轻意识障碍,降低30d死亡率,改善预后。

Objective A prospective study of patients with acute cerebral hemorrhage within 24h of onset at our hospital was carried out to explore the relationship between blood pressure level and prognosis,so as to provide reference for the blood pressure control during treatment of patients with cerebral hemorrhage.Methods 158 patients with acute cerebral hemorrhage admitted and treated at our hospital from January 2015 to January 2018 were selected as the study objects.The patient’s blood pressure level was measured every hour after admission,and the mean arterial pressure(MAP)within 24h was calculated.The patients were divided into 3 groups:MAP≥140mm Hg was the group with elevated blood pressure;90mm Hg<MAP<140mm Hg was the group with normal blood pressure;MAP≤90mm Hg was the group with reduced blood pressure.General information of the patients was collected,and the prognosis of the patients was followed up for 30d and compared.Results There were statistically significant differences in age,GCS score and hematoma volume at 24h after admission of patients among the three groups(P<0.05);pairwise comparison showed that the age and hematoma volume at 24h after admission in the group with elevated blood pressure were higher than those in the group with normal blood pressure and the group with reduced blood pressure,while the GCS score at 24h after admission in the group with elevated blood pressure and the group with reduced blood pressure was lower than that in the group with normal blood pressure,with statistically significant difference(P<0.05).All patients were followed up.A total of 41 patients died,with a mortality rate of 25.95%.The mortality rate at 30d in the group with elevated blood pressure was significantly higher than that in the group with normal blood pressure(P<0.017).The modified Rankin scale(mRS)assessment showed that the prognosis in the group with normal blood pressure was significantly better than that in the group with elevated blood pressure and the group with reduced blood pressure(P<0.017).K-M survival analysis showed that the survival rate in the group with normal blood pressure was significantly higher than that in the group with elevated blood pressure and the group with reduced blood pressure.Conclusion For patients with acute cerebral hemorrhage,active control of MAP at 90-140mm Hg can reduce the risk of continued hemorrhage,reduce the disturbance of consciousness,reduce the mortality rate at 30d,and improve the prognosis.