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目的探讨急性脑出血患者90 d临床预后的相关危险因素,并分析脑出血最初24 h血压变异性与预后的关系。方法选取徐州市中心医院神经内科2013年10月~2016年1月收治6 h内入院的高血压性脑出血患者124例。用mRS(modified Rankin Scale)量表表示患者90 d临床预后,0~1分判定预后良好组及2~6分为预后不良组,分别记录入院后24 h内不同时间段的的收缩压和舒张压(32次血压值),用血压标准差(SD)、变异系数(CV)及最大-最小差值(Max-Min)来表示血压波动性(BPV)。用多因素logistic回归分析血压波动性与患者90 d临床预后的关系。结果 (1)2组基线水平(年龄、性别、血肿体积、入院神经功能评分如GCS,NIHSS)无明显差异(P>0.05),2组血压波动性有明显差异(P<0.05);(2)spearman相关分析显示收缩压的BPV(SD、CV、Max-Min)与90 d临床预后呈正相关,其相关系数分别为0.188,0.35,0.272,P均<0.05;(3)多因素Logisitic回归分析显示收缩压及舒张压的SD、CV、Max-Min与90 d临床预后有关,其中收缩压OR分别为5.12,3.477,5.12,P均<0.01;舒张压OR分别为1.35,2.24,1.04,P均<0.05。结论急性高血压性脑出血患者的最初24 h收缩压的血压波动性是影响90 d临床预后的重要因素,早期平稳降压有利于临床预后。
Objective To investigate the risk factors of 90-day clinical prognosis in patients with acute cerebral hemorrhage and to analyze the relationship between blood pressure variability and prognosis in the first 24 hours of cerebral hemorrhage. Methods A total of 124 patients with hypertensive intracerebral hemorrhage admitted within 6 hours from October 2013 to January 2016 in Department of Neurology, Xuzhou Central Hospital were enrolled. The mRs (modified Rankin Scale) scale was used to show the clinical prognosis of the patients at 90 days. The patients with good prognosis were scored at 0 to 1 and the patients with poor prognosis at 2 to 6 were recorded. Systolic blood pressure and diastolic blood pressure were recorded at different time points The blood pressure variability (BPV) was expressed as the standard deviation (SD), the coefficient of variation (CV) and the maximum-minimum difference (Max-Min) Multivariate logistic regression analysis was used to analyze the relationship between blood pressure variability and clinical outcomes at 90 days. Results There was no significant difference in baseline blood pressure (age, sex, hematoma volume, admission neurological score such as GCS and NIHSS) between the two groups (P> 0.05) ) Spearman correlation analysis showed that systolic BPV (SD, CV, Max-Min) was positively correlated with 90-day clinical prognosis, the correlation coefficients were 0.188,0.35,0.272, P <0.05 respectively. (3) Multivariate logistic regression analysis The systolic and diastolic pressures of SD, CV and Max-Min were related to the 90-day clinical prognosis. The systolic blood pressure was 5.12, 3.477 and 5.12, respectively, P <0.01. The diastolic blood pressure was 1.35, 2.24 and 1.04, P All <0.05. Conclusion The blood pressure fluctuation of systolic blood pressure in the first 24 h in patients with acute hypertensive intracerebral hemorrhage is an important factor affecting the 90-day clinical prognosis. Early stable blood pressure is beneficial to clinical prognosis.