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目的探讨急性期脑卒中血压变化规律、影响因素及血压和预后的关系。方法对发病24 h以内入院的226例脑卒中患者连续监测10 d血压,随访1月死亡及6月死亡/残疾及复发情况。结果急性期脑卒中高血压的发生率为81.9%,入院后第6天血压基本稳定。多元线性逐步回归分析显示,脑卒中类型独立影响入院时血压且影响最大,高血压病史、吸烟史影响入院时收缩压(SBP),年龄、发病至入院时间影响入院时舒张压(DBP)。急性期脑卒中血压和预后呈U型关系,入院时血压在150/90 mm Hg左右、第1~6天血压在140/90 mm Hg左右预后较好。多因素Logistic回归分析显示,入院后第24小时SBP<120 mm Hg独立影响脑卒中1月死亡,入院后24小时内DBP下降程度及第42小时DBP独立影响6月死亡/残疾。亚组分析显示,入院后第24小时SBP<120 mm Hg独立影响脑梗死1月死亡,入院时SBP<140 mm Hg、入院后第24小时SBP<120 mmHg及DBP<90 mm Hg均独立影响6月死亡/残疾;入院第4天平均SBP独立影响脑出血1月死亡,入院后24 h内DBP下降程度及第5天平均SBP独立影响6月死亡/残疾。结论急性期脑卒中血压常升高,血压呈自发下降趋势。急性期脑卒中血压是预后的独立影响因素。
Objective To investigate the changes of blood pressure in acute stroke, the influencing factors and the relationship between blood pressure and prognosis. Methods 226 consecutive stroke patients admitted within 24 hours after onset were monitored for blood pressure for 10 days, followed up for January death and June death / disability and recurrence. Results The incidence of stroke in acute stage was 81.9%. The blood pressure was basically stable on the 6th day after admission. Multivariate linear stepwise regression analysis showed that stroke type independently influenced blood pressure at hospital admission and had the greatest impact. The history of hypertension and smoking history influenced SBP, age, incidence to admission time and diastolic blood pressure (DBP) at admission. Acute stroke blood pressure and prognosis showed a U-type relationship, admission blood pressure in the 150/90 mm Hg about the 1st to 6th day blood pressure at 140/90 mm Hg or so good prognosis. Multivariate logistic regression analysis showed SBP <120 mm Hg at 24 hours after admission independently affected deaths from stroke in January, DBP decline within 24 hours after admission and DBP at 42 hours independently affected death / disability in June. Subgroup analyzes showed SBP <120 mm Hg independently affected cerebral infarction death in January at 24 hours after admission, SBP <140 mm Hg on admission, SBP <120 mm Hg 24 hours after admission, and DBP <90 mm Hg independently affected 6 Monthly death / disability; average SBP on day 4 of hospital admission independently affected deaths of cerebral hemorrhage in January, extent of DBP decline within 24 h after admission, and average SBP on day 5 independently affected death / disability in June. Conclusion Acute stroke often increases blood pressure, blood pressure showed a spontaneous decline. Acute stroke blood pressure is an independent prognostic factor.