本文關(guān)鍵詞： 腦卒中 血壓 變化規(guī)律 影響因素 腦卒中 血壓 預(yù)后　出處：《蘇州大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：第一部分腦卒中急性期血壓的變化規(guī)律及影響因素的研究 目的：研究腦卒中急性期血壓的變化規(guī)律，分析其影響因素。 方法：收集發(fā)病24小時(shí)內(nèi)入院的急性腦卒中患者1461例。監(jiān)測(cè)入院后7天內(nèi)血壓，對(duì)患者既往相關(guān)病史及病程中伴發(fā)疾病進(jìn)行評(píng)分，，記錄入院后血壓的治療情況等。觀察入院后7天內(nèi)的血壓變化規(guī)律，分析其影響因素。對(duì)所得數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。 結(jié)果：（1）腦卒中急性期血壓升高，以收縮壓升高為主，79.3%的患者入院時(shí)收縮壓升高，并且存在自發(fā)性下降趨勢(shì)，入院后血壓在8小時(shí)內(nèi)下降最顯著，36小時(shí)后血壓趨于穩(wěn)定。（2）出血性卒中患者各時(shí)間點(diǎn)血壓均顯著高于缺血性卒中患者（P=0.000），前者在入院96小時(shí)后趨于穩(wěn)定，后者在入院36小時(shí)后基本穩(wěn)定。（3）缺血性卒中患者TOAST分型后大動(dòng)脈粥樣硬化型收縮壓高于其他各亞型（P0.05）。各亞型入院后血壓均呈下降趨勢(shì)，大動(dòng)脈粥樣硬化型血壓變化趨勢(shì)較其他各型平穩(wěn)。（4）既往有高血壓史者的入院時(shí)收縮壓、第1天平均收縮壓和7天內(nèi)平均血壓高于無(wú)高血壓史者（P0.05）。有高血壓史規(guī)律服藥組與不規(guī)律或未服藥組之間血壓無(wú)顯著性差異（P0.05）�？傮w入院后降壓治療組急性期各時(shí)間點(diǎn)血壓水平高于未降壓組（P=0.000）。（5）頸部血管病變組與無(wú)頸部血管病變組各時(shí)間點(diǎn)血壓、24小時(shí)血壓下降率和7天血壓連續(xù)性變異率比較無(wú)顯著性差異（P0.05）。頸部血管斑塊組與狹窄組比較亦無(wú)顯著性差異（P0.05）。（6）獨(dú)立影響急性期血壓的主要因素有卒中類型、伴發(fā)疾病評(píng)分、高血壓史和年齡。年齡與入院時(shí)舒張壓、第1天和7天平均舒張壓呈負(fù)相關(guān)。 結(jié)論：腦卒中急性期血壓升高，并有自發(fā)性下降趨勢(shì)。出血性卒中患者血壓要高于缺血性卒中患者。獨(dú)立影響卒中急性期血壓的主要因素有卒中類型、伴發(fā)疾病評(píng)分、高血壓史和年齡。年齡與各時(shí)間點(diǎn)舒張壓呈負(fù)相關(guān)。 第二部分腦卒中急性期血壓與預(yù)后的相關(guān)研究 目的：研究腦卒中急性期血壓與預(yù)后的關(guān)系。 方法：收集發(fā)病24小時(shí)內(nèi)入院的急性腦卒中患者1461例。監(jiān)測(cè)入院后7天內(nèi)血壓，對(duì)患者既往相關(guān)病史及病程中伴發(fā)疾病進(jìn)行評(píng)分，記錄入院后血壓的治療情況以及病情變化等。評(píng)價(jià)入院時(shí)和6個(gè)月后患者神經(jīng)功能缺損程度（采用美國(guó)國(guó)立衛(wèi)生研究院卒中量表，NIHSS）和日常生活能力（采用Barthel Index，BI）。終點(diǎn)事件為發(fā)病6個(gè)月時(shí)死亡和死亡/殘疾。對(duì)所得數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。 結(jié)果：（1）腦卒中急性期入院時(shí)收縮壓、第1天和7天平均收縮壓均與不良預(yù)后呈J型關(guān)系，收縮壓在90~120mmHg時(shí)預(yù)后最好，隨著收縮壓的升高6月死亡率和死亡/殘疾率增加。舒張壓在70~80mmHg時(shí)預(yù)后最好。缺血性卒中患者第1天平均收縮壓與不良預(yù)后呈J型關(guān)系，收縮壓在90~120mmHg時(shí)預(yù)后最佳。7天平均舒張壓與不良預(yù)后呈U型關(guān)系，舒張壓在70~80mmHg時(shí)預(yù)后最好。入院時(shí)收縮壓及舒張壓與預(yù)后無(wú)關(guān)（P0.05）。出血性卒中第1天和7天平均收縮壓與6月預(yù)后呈U型關(guān)系，收縮壓在140~160mmHg時(shí)預(yù)后最好。（2）總體24小時(shí)舒張壓下降率與預(yù)后呈U型關(guān)系，血壓下降率在0~10%時(shí)預(yù)后最好，血壓下降率低于或高于此范圍預(yù)后皆差。7天血壓連續(xù)性變異率與預(yù)后呈U型關(guān)系，變異率在5~10mmHg時(shí)預(yù)后最佳。缺血性卒中組7天血壓連續(xù)性變異率在5~10mmHg時(shí)預(yù)后最好。缺血性卒中組24小時(shí)血壓下降率各分組間預(yù)后無(wú)顯著性差異（P0.05）。出血性卒中組血壓7天血壓連續(xù)性變異率在5~15mmHg之間時(shí)預(yù)后最好。出血性卒中組24小時(shí)血壓下降率與預(yù)后無(wú)關(guān)（P0.05）。（3）經(jīng)Logistic回歸分析，獨(dú)立影響6月預(yù)后的血壓因素為：入院時(shí)收縮壓、血壓連續(xù)性變異率（包括收縮壓和舒張壓）。整體影響6月預(yù)后的因素有年齡、既往史評(píng)分、伴發(fā)疾病評(píng)分、入院時(shí)神志、NIHSS評(píng)分、7天加重和降壓治療。 結(jié)論：卒中急性期血壓與預(yù)后大致呈J型關(guān)系，與收縮壓關(guān)系更密切，隨著收縮壓的升高死亡率和死亡/殘疾率增加。舒張壓在70~80mmHg時(shí)預(yù)后最好。24小時(shí)血壓下降率在0~10%時(shí)預(yù)后最好。7天血壓連續(xù)性變異率在5~10mmHg時(shí)預(yù)后最好。入院時(shí)收縮壓、血壓連續(xù)性變異率（包括收縮壓和舒張壓）獨(dú)立影響6月預(yù)后。
[Abstract]:Study on the changes and influencing factors of blood pressure in the first part of the acute stage of stroke
Objective: To study the changes of blood pressure in acute cerebral apoplexy and analyze its influencing factors.
Methods: 1461 patients with acute stroke were collected within 24 hours from onset. The blood pressure within 7 days after admission of patients monitoring, medical history and the course of diseases were recorded after admission blood pressure treatment. The variation of blood pressure was observed within 7 days after admission, and analyze its influence factors. Statistical analysis on the data.
Results: (1) blood pressure in acute stroke increased with elevated systolic blood pressure, 79.3% patients with elevated systolic blood pressure, and the presence of spontaneous decreased blood pressure after admission in 8 hours decreased significantly, 36 hours after the blood pressure tends to be stable. (2) hemorrhagic stroke patients at each time point of blood pressure was significantly higher than that in patients with ischemic stroke (P=0.000), the former tends to be stable in 96 hours after admission, the latter in 36 hours after admission is basically stable. (3) TOAST in ischemic stroke patients after classification of large artery atherosclerosis with systolic blood pressure higher than other subtypes (P0.05) subtypes. After admission, blood pressure decreased, large artery atherosclerosis blood pressure change trend is the steady. (4) a previous history of hypertension of the admission systolic blood pressure, mean blood pressure of first days and 7 days average systolic blood pressure higher than those without hypertension history (P0.05). Regular medication group and no history of hypertension There was no significant difference between the regular or non medicine group blood pressure (P0.05). The overall level of blood pressure after admission of antihypertensive treatment in acute stage of each time point was higher than the blood pressure group (P=0.000). (5) cervical vascular lesions group and no neck vascular disease group at each time point of blood pressure, blood pressure decline rate of 24 hours and 7 days of continuous blood pressure mutation rate showed no significant difference (P0.05). Carotid plaque group and stenosis group had no significant difference (P0.05). (6) a type of stroke independent factors related to acute blood pressure, concomitant disease score, history of hypertension and age. Age and diastolic blood pressure on admission, first days and the 7 day average diastolic blood pressure was negatively correlated.
Conclusion: the blood pressure in acute stroke increased, and decreased spontaneous hemorrhagic stroke. Blood pressure is higher than that of patients with ischemic stroke. A stroke type independent main influencing factors of blood pressure in patients with acute stroke, comorbidity score, history of hypertension and age. Age and diastolic blood pressure at each time point was negatively correlated.
The correlation of blood pressure and prognosis in the second part of acute stroke
Objective: To study the relationship between blood pressure and prognosis in the acute stage of stroke.
Methods: 1461 patients with acute stroke were collected within 24 hours from onset. The blood pressure within 7 days after admission of patients monitoring, medical history and the course of diseases were recorded after admission blood pressure treatment and changes of disease. Patients with neurological deficits on admission and after 6 months (the United States National Institutes of health stroke scale, NIHSS) and the ability of daily life (Barthel Index, BI). End point events for 6 months after onset of death and death / disability. The obtained data were statistically analyzed.
Results: (1) hospitalized acute stroke when the systolic blood pressure, first days and 7 days average systolic blood pressure were associated with poor prognosis in J, systolic blood pressure in 90~120mmHg when the best prognosis, with elevated systolic blood pressure of the June mortality and death / disability rate increased. Diastolic blood pressure at 70~80mmHg. The prognosis of ischemic first stroke patients day average systolic blood pressure and adverse outcomes were J type relationship, systolic blood pressure at 90~120mmHg days.7 the best prognosis of average diastolic blood pressure was correlated with poor prognosis of U, diastolic blood pressure in 70~80mmHg. The best prognosis when admission systolic blood pressure and diastolic blood pressure and prognosis (P0.05). Hemorrhagic stroke first days and 7 days the average systolic blood pressure and prognosis in June was U, the systolic blood pressure in 140~160mmHg when the best prognosis. (2) the overall rate of decline was 24 hour diastolic blood pressure U and prognosis, blood pressure decline rate in 0~10% when the best prognosis, blood pressure decline rate is lower or higher than this range of prognosis All.7 days continuous blood pressure variation rate was U and prognosis, the mutation rate in 5~10mmHg. The best prognosis of ischemic stroke group 7 days continuous variation rate of blood pressure in 5~10mmHg. The best prognosis of ischemic stroke group 24 hours blood pressure decline rate among different groups with no significant difference (P0.05). Blood pressure stroke group 7 days continuous blood pressure variation rate of the best prognosis between 5~15mmHg. Hemorrhagic stroke group 24 hours blood pressure decline rate and prognosis (P0.05). (3) by Logistic regression analysis, independent prognostic factors affecting blood pressure in June for admission systolic blood pressure, blood pressure variability (including continuous systolic and diastolic the influence factors of pressure). In June the prognosis scores of medical history, age, comorbidity score, consciousness on admission, NIHSS score, 7 days increase and antihypertensive treatment.
Conclusion: acute stroke blood pressure and prognosis is approximately J, and a closer relationship with systolic blood pressure, systolic blood pressure increased the mortality and death / disability rate increased. The diastolic pressure in 70~80mmHg prognosis.24 hours best blood pressure decline rate in 0~10% when the best prognosis.7 days of continuous variation in blood pressure rate 5~10mmHg the best prognosis. The admission systolic blood pressure, blood pressure variability (including continuous systolic and diastolic blood pressure) June independent influence prognosis.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R743.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 沈明強(qiáng);邵國(guó)富;;卒中急性期血壓的變化規(guī)律及影響因素研究[J];神經(jīng)疾病與精神衛(wèi)生;2008年04期

2 劉勇紅,萬(wàn)琪,張光運(yùn),張志軍,葛偉,薛福波;高血壓腦出血患者30天預(yù)后的影響因素[J];中華老年心腦血管病雜志;2002年05期

3 饒明俐;;《中國(guó)腦血管病防治指南》摘要(四)[J];中風(fēng)與神經(jīng)疾病雜志;2006年02期

4 譚燕;劉鳴;王清芳;陽(yáng)清偉;談頌;吳波;;腦卒中急性期血壓變化及其影響因素[J];高血壓雜志;2005年11期

5 譚燕;劉鳴;王清芳;陽(yáng)清偉;談頌;吳波;;腦卒中急性期血壓與預(yù)后的關(guān)系[J];中華神經(jīng)科雜志;2006年01期

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