本文選題：腦血管病　切入點：急性腦梗死　出處：《廣西醫(yī)科大學》2013年碩士論文

【摘要】：研究目的：探討急性腦梗死患者不同血壓類型與動脈硬化指數(shù)和早期病情輕重及生活質(zhì)量關系。 研究方法：研究對象為2012年11月至2013年2月在廣西壯族自治區(qū)人民醫(yī)院神經(jīng)內(nèi)科住院的急性腦梗死患者。對符合納入標準的患者行24h動態(tài)血壓監(jiān)測(24hours Ambulatory blood pressure monitoring,24h ABPM),記錄患者一般資料、動態(tài)血壓監(jiān)測參數(shù),發(fā)病第7天予美國國立衛(wèi)生研究院卒中量表(National Institutes of Health Stroke Scale NIHSS)評分、EQ-5D量表(健康指數(shù)、EQ-VAS得分)評分。根據(jù)入院時24hABPM監(jiān)測結果,將患者分為杓型、非杓型、反杓型三組,計算出每個患者的動脈硬化指數(shù)(Ambulatory arterial stiffness index AASI),分析三組患者間一般資料及AASI的組間差異,同時分析動態(tài)血壓各個參數(shù)與AASI相關性、三組血壓類型患者動態(tài)血壓各個參數(shù)組間差異。根據(jù)NIHSS評分評估患者神經(jīng)功能缺損情況及EQ-5D量表評分評估對患者早期病情輕重及生活質(zhì)量的影響。分析NIHSS評分、EQ-5D量表與AASI相關性。 研究結果：1、253名腦梗死急性期患者杓型血壓患者為60例,占23.72%；非杓型血壓的患者94例,占37.15%；反杓型血壓患者99例,占39.13%；原有高血壓病史患者105人,占41.50%,入院24h進行動態(tài)血壓監(jiān)測提示血壓增高者202人,占79.84%。2、三種血壓類型患者的夜間收縮壓(Night mean systolic body pressure NSBP)、夜間舒張壓(Day mean Diastolic blood pressure NDBP)、夜間脈壓(Night mean pulse pressure NPP)、晨起收縮壓(Morning systolic body pressure MSBP)、24h收縮壓(24hoursSystolic body pressure24hSBP)及24h平均動脈壓(24hours mean artery pressure24hMAP)比較差異有統(tǒng)計學意義(P0.05)。3、三種血壓類型患者的AASI比較差異有統(tǒng)計學意義(P0.05)。4、腦梗死急性期患者動態(tài)血壓參數(shù)日間脈壓(Day mean pulse pressure DPP)、NPP、24h脈壓(24hours pulse pressure24hPP)、MSBP、4hSBP與AASI呈正相關(r=0.153,0.370,0.298,0.339,0.219,0.169；P0.05)。5、三種血壓類型患者的NIHSS評分比較差異有統(tǒng)計學意義(P0.05)。6、三種血壓類型患者的EQ-5D量表評分比較差異有統(tǒng)計學意義(P0.05)。7、AASI與NIHSS評分呈正相關(r=0.456P0.01),與EQ-5D評分呈負相關(r=-0.348,-0.286；P0.01)。 研究結論：1、腦梗死急性期血壓類型以非杓型和反杓型為主2、三種血壓類型患者中,反杓型血壓動脈硬化程度重,杓型血壓動脈硬化程度輕,非杓型血壓患者介于兩者之間；3、反杓型血壓早期神經(jīng)功能缺損程度重,生活質(zhì)量低；杓型血壓早期神經(jīng)功能缺損程度輕,生活質(zhì)量高,非杓型血壓患者介于兩者之間。
[Abstract]:Objective : To investigate the relationship between different types of blood pressure in patients with acute cerebral infarction and the severity and quality of life in patients with acute cerebral infarction .

The results of 24 hours ambulatory blood pressure monitoring ( 24 hours ambulatory blood pressure monitoring , 24 hours ABPM ) , general data of the patient and the parameters of ambulatory blood pressure monitoring were recorded . The parameters of the patient ' s neurological deficit and the effect of EQ - 5D on the severity and quality of life were analyzed according to the results of 24 hours ambulatory blood pressure monitoring . The correlation between the scores of NIHSS and EQ - 5D and AASI was analyzed .

The results were as follows : 1 , 253 patients with acute stage of cerebral infarction had dipper type blood pressure ( n = 60 ) , accounting for 23.72 % ;
94 patients with non dipper blood pressure ( 37.15 % ) ;
99 cases ( 39.13 % ) of patients with anti - dipper blood pressure were reported .
There was a significant difference in ambulatory blood pressure ( NSBP ) , nocturnal diastolic blood pressure ( NDBP ) , nocturnal diastolic blood pressure ( NDBP ) , 24 hours systolic pressure ( 24 hours pulse pressure NPP ) , 24 hours pulse pressure ( 24 hours pulse pressure NPP ) , 24 hours systolic pressure ( 24 hours pulse pressure 24 hSBP ) , 24 hours mean arterial pressure ( 24 hours mean artery pressure 24 hSBP ) and 24 hours mean arterial pressure ( 24 hours mean artery pressure 24 hMAP ) .
There was a significant difference between the scores of the three types of blood pressure ( P0.05 ) . The scores of the EQ - 5D were positively correlated with the scores of the three types of blood pressure ( r = 0.456P0.01 ) , and negatively correlated with the EQ - 5D score ( r = - 0.348 , - 0.286 ) .
P0.01).


Conclusion : 1 . The type of blood pressure in the acute stage of cerebral infarction is the non dipper type and the anti - dipper type 2 . Among the three types of blood pressure , the anti - dipper type blood pressure arteriosclerosis degree is heavy , the dipper type blood pressure arteriosclerosis degree is mild , the non - dipper blood pressure patient is between the two ;
3 . The early neural function defect of anti - dipper type blood pressure is heavy and the quality of life is low ;
The early neurologic impairment of dipper type blood pressure is mild , the quality of life is high , and the non - dipper blood pressure patient is between the two .

【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R743.33

【參考文獻】

相關期刊論文 前10條

1 王才華;沈紅權;劉文謹;張志丹;;高血壓患者缺血性腦卒中的發(fā)生與動態(tài)血壓的相關性[J];神經(jīng)病學與神經(jīng)康復學雜志;2009年04期

2 石潔;胡元會;商秀洋;王階;高改地;宋慶橋;;老年原發(fā)性高血壓患者頸動脈病變與動態(tài)脈壓指數(shù)[J];中華高血壓雜志;2008年03期

3 張湘;羅俊;王賽華;嚴俊峰;馬玨;蘇芬;奚弘妮;蔣偉堅;孫明基;;飲酒對男性高血壓患者血壓晝夜節(jié)律的影響[J];中華高血壓雜志;2010年09期

4 劉學森;徐新娟;珠勒皮亞·司馬義;陳玉嵐;;原發(fā)性高血壓患者中心動脈壓與血壓晝夜節(jié)律異常變化的相互關系[J];中華高血壓雜志;2012年01期

5 謝旭芳;王衛(wèi)真;馮莉莉;屈新輝;吳曉牧;張昆南;;血清脂蛋白(a)和頸動脈粥樣硬化與腦梗死的相關性分析[J];中華腦血管病雜志(電子版);2010年04期

6 范煥青;張金濤;;腦梗死患者急性期血壓變化與預后關系的研究進展[J];中國現(xiàn)代醫(yī)藥雜志;2010年06期

7 蔡文雋;張微微;;概述急性腦卒中患者24h動態(tài)血壓的監(jiān)測及其作用[J];中華臨床醫(yī)師雜志(電子版);2011年07期

8 許加亮;黃秀先;梁樹俊;劉國嶺;王煥超;王曉蘭;趙景波;張紅葉;劉力生;;清河縣農(nóng)村70歲及以上老年人群血壓分布特征[J];中國慢性病預防與控制;2010年03期

9 張方;傅書勇;王曼;杜s，

本文編號：1682652