血压变异性与伴H型高血压的急性脑梗死患者预后不良的临床关系分析

Clinical relationship between blood pressure variability and poor prognosis in patients with acute cerebral infarction and H-type hypertension

目的探讨伴H型高血压的急性脑梗死(ACI)患者血压变异性(BPV)变化及与预后的关系。方法选取如皋市人民医院神经内科自2021年3月至2022年3月收治的88例伴H型高血压的ACI患者作为H型高血压ACI组,并选取同期40例单纯伴高血压ACI患者作为单纯高血压ACI组。2组患者均行24 h血压监测,记录并对比2组患者的BPV参数。根据治疗后3个月的改良Rankin量表(mRS)评分,将H型高血压ACI组患者分为预后良好和预后不良2个亚组,评估其美国国立卫生研究院卒中量表(NIHSS)评分差异,分析BPV与预后的关系。结果H型高血压ACI组的24 h收缩压变异系数(24 h SCV)、日间平均收缩压变异系数(dSCV)和夜间平均收缩压变异系数(nSCV)及治疗后3个月的NIHSS评分和mRS评分均高于单纯高血压ACI组,差异具有统计学意义(P<0.05)。H型高血压ACI组中预后良好亚组患者63例,预后不良亚组患者25例。预后不良亚组24 h SCV、dSCV、nSCV及治疗后3个月NIHSS评分高于预后良好亚组,差异具有统计学意义(P<0.05)。24 h SCV、dSCV、nSCV与mRS评分均呈正相关(r=0.247、0.357、0.471、0.378,P<0.05),nSCV与NIHSS评分呈正相关(r=0.266,P<0.05)。结论伴H型高血压ACI患者收缩压变异性增大,与患者预后存在一定相关性,可作为预测预后不良的指标。

Objective To explore the changes of blood pressure variability(BPV)and its relationship with prognosis in patients with acute cerebral infarction(ACI)and H-type hypertension.Methods A total of 88 patients with ACI and H-type hypertension admitted to Neurology Department of Rugao People's Hospital were enrolled as H-type hypertension ACI group between March 2021 and March 2022,while 40 patients with ACI and simple hypertension during the same period were enrolled as simple hypertension ACI group.Both groups of patients underwent 24 h blood pressure monitoring,and the BPV parameters of the two groups were recorded and compared.According to scores of modified Rankin scale(mRS)after 3 months of treatment,patients in H-type hypertension ACI group were divided into good prognosis group and poor prognosis group,and the differences in scores of National Institutes of Health stroke scale(NIHSS)between the two groups were compared.The relationship between BPV and prognosis was analyzed.Results The 24 h variation coefficient of systolic blood pressure(24 h SCV),variation coefficient of daytime mean systolic blood pressure(dSCV)and variation coefficient of nighttime mean systolic blood pressure(nSCV)in H-type hypertension ACI group were higher than those in simple hypertension ACI group(P<0.05).After 3 months of treatment,scores of NIHSS and mRS in H-type hypertension ACI group were higher than those in simple hypertension ACI group(P<0.05).There were 63 patients with good prognosis and 25 patients with poor prognosis in H-type hypertension ACI group.24 h SCV,dSCV and nSCV in patients with good prognosis were lower than those with poor prognosis(P<0.05).After 3 months of treatment,NIHSS score in poor prognosis group was higher than that in good prognosis group(P<0.05).24 h SCV,dSCV and nSCV were positively correlated with mRS score(r=0.247,0.357,0.471,0.378,P<0.05);nSCV was positively correlated with NIHSS score(r=0.266,P<0.05).Conclusion The variability of systolic blood pressure increases in patients with ACI and H-type hypertension,which has certain correlation with prognosis and can be applied to predict poor prognosis.