本文選題：腦血管病　切入點(diǎn)：急性腦梗死　出處：《廣西醫(yī)科大學(xué)》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(lèi)型與動(dòng)脈硬化指數(shù)和早期病情輕重及生活質(zhì)量關(guān)系。 研究方法：研究對(duì)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(duì)符合納入標(biāo)準(zhǔn)的患者行24h動(dòng)態(tài)血壓監(jiān)測(cè)(24hours Ambulatory blood pressure monitoring,24h ABPM),記錄患者一般資料、動(dòng)態(tài)血壓監(jiān)測(cè)參數(shù),發(fā)病第7天予美國(guó)國(guó)立衛(wèi)生研究院卒中量表(National Institutes of Health Stroke Scale NIHSS)評(píng)分、EQ-5D量表(健康指數(shù)、EQ-VAS得分)評(píng)分。根據(jù)入院時(shí)24hABPM監(jiān)測(cè)結(jié)果,將患者分為杓型、非杓型、反杓型三組,計(jì)算出每個(gè)患者的動(dòng)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(shí)分析動(dòng)態(tài)血壓各個(gè)參數(shù)與AASI相關(guān)性、三組血壓類(lèi)型患者動(dòng)態(tài)血壓各個(gè)參數(shù)組間差異。根據(jù)NIHSS評(píng)分評(píng)估患者神經(jīng)功能缺損情況及EQ-5D量表評(píng)分評(píng)估對(duì)患者早期病情輕重及生活質(zhì)量的影響。分析NIHSS評(píng)分、EQ-5D量表與AASI相關(guān)性。 研究結(jié)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(jìn)行動(dòng)態(tài)血壓監(jiān)測(cè)提示血壓增高者202人,占79.84%。2、三種血壓類(lèi)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(dòng)脈壓(24hours mean artery pressure24hMAP)比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3、三種血壓類(lèi)型患者的AASI比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4、腦梗死急性期患者動(dòng)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(guān)(r=0.153,0.370,0.298,0.339,0.219,0.169；P0.05)。5、三種血壓類(lèi)型患者的NIHSS評(píng)分比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。6、三種血壓類(lèi)型患者的EQ-5D量表評(píng)分比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。7、AASI與NIHSS評(píng)分呈正相關(guān)(r=0.456P0.01),與EQ-5D評(píng)分呈負(fù)相關(guān)(r=-0.348,-0.286；P0.01)。 研究結(jié)論：1、腦梗死急性期血壓類(lèi)型以非杓型和反杓型為主2、三種血壓類(lèi)型患者中,反杓型血壓動(dòng)脈硬化程度重,杓型血壓動(dòng)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(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R743.33

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