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背景:认识血压的不同成分对脑血管病的影响及在疾病不同情况下正确使用降压治疗均具有重要意义。目的:通过对急性脑梗死患者的入院脉压分析,探讨脉压增大与脑梗死的发生、严重程度的相关性。设计:病例-对照分析。单位:哈尔滨医科大学附属第一医院。对象:病例组为2002-06/2003-01因缺血性脑梗死入住哈尔滨医科大学附属第一医院的患者300例,男196例,女104例鸦年龄(57.9±11.9)岁。正常组为在同期来本院进行体检者199例,男110例,女89例鸦年龄(55.9±12.4)岁。方法:①血压测量:安静状态下应用水银柱血压计按标准方法选择右上肢肱动脉处测血压。记录患者的收缩压和舒张压,并计算脉压。②神经功能缺损评分:应用美国国立卫生研究院卒中量表在入院时对每例缺血性脑梗死患者进行临床神经功能缺损评分,以入院时评分作为脑卒中严重程度的评价指标,分值越大,脑卒中程度越重。主要观察指标:①两组对象血压各参数比较。②两组对象中不同脉压水平人员分布情况。③两组中不同年龄段人群脉压比较。④不同脉压水平脑梗死患者神经功能缺失评分非参数检验结果。结果:①平均收缩压:病例组明显高于对照组眼(152±22),(133±19)mmHg,t’=10.494,P<0.01演。平均舒张压:病例组明显高于对照组眼(93±14),(81±11)mmHg,t’=10.129,P<0.01演。平均脉压:病例组脉压高于对照组眼(59.61±11.86),(51.93±14.10)mmHg,t’=5.612,P<0.05演。两两相关分析结果显示,脉压与收缩压的Pearson相关系数为0.789(P<0.01),脉压与舒张压的Pearson相关系数为0.169(P<0.01),故可以认为脉压与收缩压的相关性更密切。②在病例组,脉压最大的分布区域在60～69mmHg,占27.7%;对照组脉压最大的分布区域在40～49mmHg,占35.7%。提示脑梗死时脉压大于60mmHg的发生率较高。③随着年龄的增加,脉压增大。40～69岁病例组的脉压水平明显高于同年龄对照组眼(54±16),(45±9)mmHg,t=4.86,P=0.000演。④不同脉压水平脑梗死患者进行入院神经功能缺失评分的非参数检验,结果为Kruskal-Wallis检验统计量如下:χ2=4.779,P=0.572>0.05;中位数检验的检验统计量如下:χ2=8.365,P=0.213>0.05。两种非参数检验结果提示入院评分差异无显著性,也就是说脑梗死时虽然脉压明显升高,但脉压增高的程度与神经功能缺失的严重程度无关。结论:脉压的增大与脑梗死的发生有关,是脑梗死发生的重要评价因素,但脉压的变化并不与脑梗死的严重程度相关。
Background: It is of great importance to know the influence of different components of blood pressure on cerebrovascular disease and to correctly use antihypertensive treatment in different situations of the disease. OBJECTIVE: To investigate the relationship between the increase of pulse pressure and the occurrence and severity of cerebral infarction by analyzing the pulse pressure of admission in patients with acute cerebral infarction. Design: Case-control analysis. Unit: First Affiliated Hospital of Harbin Medical University. PARTICIPANTS: The case group consisted of 300 patients admitted to the First Affiliated Hospital of Harbin Medical University from June 2002 to January 2003 due to ischemic stroke. There were 196 males and 104 females aged 57.9 ± 11.9 years. In the normal group, 199 cases were examined in our hospital during the same period, including 110 males and 89 females aged 55.9 ± 12.4 years. Methods: ① blood pressure measurement: quiet state, the use of mercury sphygmomanometer standard method to select the right upper arm brachial artery to measure blood pressure. Patients were recorded systolic and diastolic blood pressure, and calculate pulse pressure. ② neurological deficit score: application of the National Institutes of Health Stroke Scale at admission to each case of patients with ischemic cerebral infarction clinical neurological deficit score to hospital admission score as an assessment of the severity of stroke index scores Large, the more severe stroke. MAIN OUTCOME MEASURES: ① Comparison of blood pressure parameters between two groups. ② two groups of subjects in different pulse pressure level distribution of personnel. ③ Comparison of pulse pressure among different age groups in both groups. ④ different pulse pressure levels in patients with neurological deficit score nonparametric test results. Results: ① The average systolic blood pressure: the case group was significantly higher than that of the control group (152 ± 22), (133 ± 19) mmHg, t ’= 10.494, P <0.01. Mean diastolic blood pressure: The case group was significantly higher than that of the control group (93 ± 14), (81 ± 11) mmHg, t ’= 10.129, P <0.01. Mean pulse pressure: The pulse pressure in case group was higher than that in control group (59.61 ± 11.86), (51.93 ± 14.10) mmHg, t ’= 5.612, P <0.05. Correlation analysis showed that the Pearson correlation coefficient between pulse pressure and systolic pressure was 0.789 (P <0.01), and the Pearson correlation coefficient between pulse pressure and diastolic pressure was 0.169 (P <0.01), so the pulse pressure and systolic pressure More relevant. ② In the case group, the maximum pulse pressure distribution ranged from 60 to 69 mmHg, accounting for 27.7%. In the control group, the maximum pressure distribution ranged from 40 to 49 mmHg, accounting for 35.7%. Tip cerebral infarction pulse pressure greater than 60mmHg higher incidence. ③ with age, pulse pressure increases. Pulse pressure was significantly higher in the 40- to 69-year-old group than in the same age group (54 ± 16), (45 ± 9) mmHg, t = 4.86, P = 0.000. The results of Kruskal-Wallis test statistic are as follows: χ2 = 4.779, P = 0.572> 0.05; The test statistic of median test is as follows: χ2 = = 8.365, P = 0.213> 0.05. Two non-parametric test results showed no significant difference in admission scores, that is, although cerebral infarction significantly increased pulse pressure, but the degree of increased pulse pressure and the severity of nerve function loss has nothing to do. Conclusion: The increase of pulse pressure is related to the occurrence of cerebral infarction. It is an important factor to evaluate the occurrence of cerebral infarction. However, the change of pulse pressure is not related to the severity of cerebral infarction.