急性缺血性脑卒中患者血压水平与TOAST分型、神经功能缺损程度及预后的关系分析

Relationship between blood pressure level and TOAST classification,degree of neurological impairment,prognosis in patients with acute ischemic stroke

目的分析急性缺血性脑卒中患者血压水平与脑梗死病因TOAST分型、神经功能缺损程度及预后的关系。方法选取2021年1月—2023年1月大同国药同煤总医院神经内科收治的急性缺血性脑卒中患者106例,按高血压分级标准进行分组,BP≤140/90 mmHg的正常血压患者为A组(25例),BP 141~180/91~110 mmHg的轻度及中度高血压患者为B组(67例),BP≥181/111 mmHg的重度高血压患者为C组(14例)。测定各组患者入院TOAST分型,采用美国国立卫生院卒中量表(NIHSS)评分评估神经功能缺损情况,采用改良Barthel指数(MBI)评估患者预后,并分析患者血压水平与上述指标的关系。多因素Logistic回归分析急性缺血性脑卒中患者预后的影响因素。结果106例患者中,动脉粥样硬化型(LAA)组卒中52例,心源性栓塞型(CE)组卒中24例,小动脉病变型(SAO)组卒中30例,CE型患者入院时收缩压低于LAA型、SAO型(P<0.05);C组患者的入院时NIHSS评分均明显高于A组、B组(P=0.005,<0.001);治疗3个月后随访,B组患者MBI评分显著高于A组、C组(P<0.05);依据MBI评分>60分患者74例纳入预后良好亚组,分值≤60分的32例患者纳入预后不良亚组,2亚组患者入院时NIHSS评分、入院24 h收缩压、舒张压下降情况比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示入院时NIHSS评分高、入院24 h收缩压下降≥20 mmHg、舒张压下降≥10 mmHg均为急性缺血性脑卒中预后的危险因素[OR(95%CI)=2.428(1.053~5.595)、3.251(1.166~9.062)、3.483(1.109~10.942),P<0.05]。结论CE型脑卒中患者入院时收缩压低于LAA型、CE型,且不同血压水平患者NIHSS评分以及MBI评分亦存在差异,入院时NIHSS评分、入院24 h血压下降均为预后的影响因素。

Objective To analyze the relationship between blood pressure level and the causes of cerebral infarction in TOAST classification,degree of neurological impairment,prognosis in patients with acute ischemic stroke.Methods A total of 106 patients with acute ischemic stroke who were admitted to the Department of Neurology,Sinopharm Tongmei General Hospital from January 2021 to January 2023 were selected.According to the classification criteria for hypertension,the patients were divided into group A(normal hypertension,BP≤140/90 mmHg,25 cases),group B(mild to moderate hypertension,BP of 140-180/91-110 mmHg,67 cases)and group C(severe hypertension,BP≥180/111 mmHg,14 cases).TOAST type of each group was determined at admission.The National Institutes of Health Stroke Scale(NIHSS)score was used to evaluate the degree of neurological impairment and the modified Barthel index(MBI)was used to evaluate the prognosis.The relationship between blood pressure level and above indicators was analyzed.Results Among the 106 patients,there were 52 patients with large artery atherosclerosis(LAA)-type stroke,24 patients with cardiogenic embolism(CE)-type stroke and 30 patients with small artery occlusion(SAO)-type stroke.Systolic blood pressure of CE group was lower than that of LAA group and SAO group at admission(P<0.05).The NIHSS scores of group C at admission were significantly higher than those of group B and group A(P=0.005,<0.001).During 3 months of follow-up after treatment,MBI scores of group B were significantly higher than those of group A and group C(P<0.05).According to the MBI score,the patients were divided into good prognosis subgroup(74 patients with MBI score>60)and poor prognosis subgroup(32 patients with MBI score≤60).There was statistically significant difference in NIHSS score at admission and decreases in systolic and diastolic blood pressure in 24h after admission between the 2 groups(P<0.05).Multivariate Logistic regression analysis found that the NIHSS score high at admission,decreases in systolic blood pressure and diastolic blood pressure in 24h after admission were prognostic factors of acute ischemic stroke[OR(95%CI)=2.428(1.053-5.595),3.251(1.166-9.062),3.483(1.109-10.942),P<0.05].Conclusion Patients with CE-type acute ischemic stroke have lower systolic blood pressure than those with LAA-type and CE-type acute ischemic stroke at admission.Besides,patients with different blood pressure levels have different NIHSS scores and MBI scores.The NIHSS score at admission and decrease in blood pressure in 24h after admission are prognostic factors.