老年急性缺血性脑卒中患者直立性低血压状态与卒中后认知障碍相关性研究

Association between orthostatic hypotension and poststroke cognitive impairment in elderly acute ischemic stroke patients

目的前瞻性分析老年急性缺血性脑卒中患者直立性低血压(orthostatic hypotension,OH)状态与卒中后认知障碍(post-stroke cognitive impairment,PSCI)的相关性。方法连续纳入2018年10月~2019年12月西部战区总医院神经内科住院的首次发病的急性缺血性脑卒中患者206例,根据发病后5~7 d直立倾斜试验结果分为OH组61例和非OH组145例,采用简易智能状态检查量表(MMSE)评估分析脑卒中后3个月的认知功能状态,采用logistic回归分析OH与PSCI的相关性。结果本研究OH患病率为29.61%,PSCI患病率为55.83%。OH组年龄,冠心病,吸烟比例,收缩压及PSCI发生率明显高于非OH组[72.0(67.0,77.0)岁vs 66.0(63.0,69.5)岁,P=0.000;32.79%vs 15.86%,P=0.006;55.74%vs 37.24,P=0.014;150.0(140.0,166.0)mm Hg(1 mm Hg=0.133 kPa)vs 145.0(130.0,160.0)mm Hg,P=0.037;90.16%vs 41.38%,P=0.000],入院MMSE评分明显低于非OH组[27.0(27.0,28.0)分vs 28.0(27.0,28.0)分,P=0.000],2组TOAST分型构成比比较,差异有统计学意义(P=0.012)。OH组PSCI患者MMSE评分、即刻记忆、注意力和计算力、回忆能力明显低于非OH组PSCI患者(P<0.05,P<0.01)。多因素logistic回归分析,OH是PSCI发生的独立危险因素(OR=9.687,95%CI:3.425~27.397,P<0.01)。结论老年急性缺血性脑卒中发病后5~7 d OH状态是脑卒中后3个月PSCI独立危险因素,及时评估OH状态可较好预警老年脑卒中患者的PSCI状态。

Objective To prospectively analyze the association between orthostatic hypotension(OH)and post-stroke cognitive impairment(PSCI)in elderly acute ischemic stroke(AIS)patients.Methods Two hundred and six first-ever elderly AIS patients admitted to General Hospital of Western Theater Command from October 2018 to December 2019 were divided into OH group(n=61)and OH-free group(n=145)according to the upright-tilt-test on days 5-7 after onset of AIS.Their cognitive function was assessed according to their MMSE Scale score at month 3 after onset of AIS.The association between OH and PSCI in elderly AIS patients was analyzed by logistic regression analysis.Results The prevalence of OH was 29.61%and that of PSCI was 55.83%.The age was significantly older,the incidence of OH,CHD,PSCI,the ratio of smoking patients and SBP were significantly higher in OH group than in OH-free group while the MMSE Scale score on admission was lower in OH group than in OH-free group[72.0(67.0,77.0)years vs 66.0(63.0,69.5)years,P=0.000;32.79%vs 15.86%,P=0.006;55.74%vs 37.24,P=0.014;150.0(140.0,166.0)mm Hg vs 145.0(130.0,160.0)mm Hg,P=0.037;90.16%vs 41.38%,P=0.000;27.0 vs 28.0,P=0.000].The TOAST classification composition ratio was significantly different between the two groups(P=0.012).The MMSE Scale score,immediate memory,attention,calculation and recall ability were significantly lower in PSCI patients of OH group than in those of OH-free group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that OH was an independent risk factor for PSCI in elderly AIS patients(OR=9.687,95%CI:3.425-27.397,P<0.001).Conclusion OH on days 5-7 after onset of AIS is an independent risk factor for PSCI at month 3 after onset of AIS.Timely assessment of OH can effectively predict PSCI in elderly AIS patients.