CAJ | 학술논문

目的探讨三种不同病因类型的缺血性脑卒中急性期血压与预后的关系.方法以温州脑卒中登记库为基础,前瞻性连续登记2007年4月至2008年4月温州医学院附属第一医院从发病到入院时间小于48 h并被诊断为脑梗死的患者.采用Logistic多因素逐步回归法分析不同病因型脑梗死患者影响预后的因素.结果各病因型入院血压和急性期平均血压与预后均呈U型关系.动脉粥样硬化型、心源性栓塞型和其他病因型入院时血压在150/95 mm Hg(1 mm Hg=0.133 kPa)左右,7 d内平均血压140/90 mm Hg时预后最佳;小动脉病变型以入院时血压在130/95 mm Hg左右,7 d内平均血压140/90 mm Hg时预后最佳.在动脉粥样硬化型缺血性脑卒中患者中,入院24 h内收缩压下降幅度大于20 mm Hg使3个月的死亡和残疾风险增加4.44倍(OR 4.44,95%CI 1.70～11.59,P=0.002);入院24 h内舒张压下降幅度大于10 mm Hg使3个月的死亡和残疾风险增加3.70倍(OR 3.70,95%CI 1.54～8.90,P=0.00).心源性脑栓塞患者中,入院24 h内收缩压下降幅度大于20 mm Hg(OR 7.98,95%CI 1.34～47.66,P=0.026)和舒张压下降幅度大于10 mm Hg(OR6.68,95%CI 1.55～28.79,P=0.01)均为3个月死亡和残疾的独立危险因素.结论入院时各亚型组的血压与3个月病死和残疾率均呈U型关系,血压过高或过低患者预后均较差.对于动脉粥样硬化型患者和心源性栓塞患者,入院24 h内血压下降幅度过大为其3个月预后不良的独立危险因素.
목적 탐토삼충불동병인류형적결혈성뇌졸중급성기혈압여예후적관계.방법 이온주뇌졸중등기고위기출,전첨성련속등기2007년4월지2008년4월온주의학원부속제일의원종발병도입원시간소우48 h병피진단위뇌경사적환자.채용Logistic다인소축보회귀법분석불동병인형뇌경사환자영향예후적인소.결과 각병인형입원혈압화급성기평균혈압여예후균정U형관계.동맥죽양경화형、심원성전새형화기타병인형입원시혈압재150/95 mm Hg(1 mm Hg=0.133 kPa)좌우,7 d내평균혈압140/90 mm Hg시예후최가;소동맥병변형이입원시혈압재130/95 mm Hg좌우,7 d내평균혈압140/90 mm Hg시예후최가.재동맥죽양경화형결혈성뇌졸중환자중,입원24 h내수축압하강폭도대우20 mm Hg사3개월적사망화잔질풍험증가4.44배(OR 4.44,95%CI 1.70～11.59,P=0.002);입원24 h내서장압하강폭도대우10 mm Hg사3개월적사망화잔질풍험증가3.70배(OR 3.70,95%CI 1.54～8.90,P=0.00).심원성뇌전새환자중,입원24 h내수축압하강폭도대우20 mm Hg(OR 7.98,95%CI 1.34～47.66,P=0.026)화서장압하강폭도대우10 mm Hg(OR6.68,95%CI 1.55～28.79,P=0.01)균위3개월사망화잔질적독립위험인소.결론 입원시각아형조적혈압여3개월병사화잔질솔균정U형관계,혈압과고혹과저환자예후균교차.대우동맥죽양경화형환자화심원성전새환자,입원24 h내혈압하강폭도과대위기3개월예후불량적독립위험인소.
Objective To investigate the relationship between blood pressure(BP) and prognosis in three different ischemic stroke subtypes.Methods The consecutive patients with a brain infarction proven on diffusion-weighted MRI who were hospitalized within 48 hours after stroke onset between April 2007 and April 2008 were registered.All subjects with acute ischemic stroke consecutively admitted to the neurological wards of the First Affiliated Hospital of Wenzhou Medical College,were registered in the Wenzhou Stroke Registry Program.Data were collected and coded at primary registration.The BP levels were studied during the initial 7 hospital days.Survival and dependency were assessed at 3 months.Outcomes were adjusted age,consciousness level,admission NIHSS score,the decline level of systolic BP,the decline level of diastolic BP,complication and so on. Logistic regression model was used to estimate the relationship between BP and prognosis.Results A U-shaped effect was observed in each subgroup between BP and prognosis.In the subgroups of atherothrombosis,cardioembolism and small artery disease,those who had a BP of 150/95 mm Hg(1 mm Hg=0.133 kPa)on admission,140/90 mm Hg on day 1-7 would have a better prognosis.In the subgroups of atherothrombosis and cardioembolism,the decrease of BP during the first 24 hours was the independent predictor of the death and disability at 3-month.In the atherothrombosis group,when the decrease of systolic BP during the first 24 hours was greater than 20 mm Hg,the risk of the death and disability at 3-month increased 4.44 times(OR 4.44,95%CI 1.70-11.59,P=0.002).In the atherothrombosis group,when the decrease of diastolic BP during the first 24 hours was greater than 10 mm Hg,the risk of the death/disability at 3-month increased 3.70 times(OR 3.70,95%CI 1.54-8.90.P=0.00).In the cardioembolism group,the risk increased respectively 7.98 times(OR 7.98,95%CI 1.34-47.66.P=0.026)and 6.68 times(OR 6.68.95%CI 1.55-28.79,P=0.01).In the subgroups of small artery disease,the decrease of BP during the first 24 hours was not the independent predictor of the death and disability at 3-month.Conclusions A U-shaped effect is observed in each subgroup between BP and prognosis.In the subgroups of atherothrombosis and cardioembolism,the decrease of BP during the first 24 hours is the independent predictor of the death and disability at 3-month.