本文關(guān)鍵詞：腦梗死急性期血壓達(dá)標(biāo)程度對(duì)短期預(yù)后的影響　出處：《華北理工大學(xué)》2016年碩士論文　論文類(lèi)型：學(xué)位論文

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【摘要】：目的探討腦梗死急性期血壓達(dá)標(biāo)程度對(duì)短期預(yù)后的影響。方法依據(jù)納入標(biāo)準(zhǔn)選取2014年1月至2014年12月于華北理工大學(xué)附屬醫(yī)院住院的首發(fā)急性腦梗死患者247例,測(cè)量患者入院后第1—14天共42次血壓。血壓達(dá)標(biāo)定義為小于140/90mm Hg且大于90/60mm Hg。血壓值達(dá)標(biāo)次數(shù)占血壓測(cè)量總次數(shù)的百分比分即為血壓達(dá)標(biāo)率,根據(jù)達(dá)標(biāo)率,按照4百分位法,將研究對(duì)象分為達(dá)標(biāo)率25%組(54例)、達(dá)標(biāo)率25%~50%組(51例)、達(dá)標(biāo)率50%~75%組(64例)、達(dá)標(biāo)率≥75%組(78例)。隨訪記錄14天及30天研究對(duì)象美國(guó)衛(wèi)生研究院卒中量表評(píng)分(NIHSS),采用生活自理程度Modified Rankin量表(m RS)為預(yù)后評(píng)判標(biāo)準(zhǔn),采用單因素及多因素logisitic回歸分析觀察血壓達(dá)標(biāo)程度對(duì)短期預(yù)后的影響。結(jié)果1各暴露組一般情況的比較中入院前服用降壓藥、入院后降壓治療差異具有統(tǒng)計(jì)學(xué)意義(P0.05);各暴露組既往史比較中高血壓病史的差異具有統(tǒng)計(jì)學(xué)意義(P0.05);各暴露組臨床生化指標(biāo)均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。2 4組間入院NIHSS評(píng)分、14天時(shí)NIHSS評(píng)分具有統(tǒng)計(jì)學(xué)差異(P0.05),入院與14天時(shí)NIHSS評(píng)分改變不具有統(tǒng)計(jì)學(xué)差異(P0.05)。3 4組間入院時(shí)NIHSS評(píng)分、30天時(shí)NIHSS評(píng)分具有統(tǒng)計(jì)學(xué)差異(P0.05),入院與30天時(shí)NIHSS評(píng)分改變不具有統(tǒng)計(jì)學(xué)差異(P0.05)。4腦梗死急性期血壓達(dá)標(biāo)程度與14天預(yù)后情況分析:單因素logisitic回歸分析,與血壓達(dá)標(biāo)率≥75%組相比,血壓達(dá)標(biāo)率25%組出現(xiàn)預(yù)后不良的危險(xiǎn)增加了1.288倍,血壓達(dá)標(biāo)率25%~50%組出現(xiàn)預(yù)后不良的危險(xiǎn)性增加了1.576倍,具有統(tǒng)計(jì)學(xué)意義(P0.05);多因素logisitic回歸分析,調(diào)整年齡、高血壓病史、糖尿病病史、血糖、發(fā)病前服用降壓藥物、降壓治療、入院NIHSS評(píng)分后,與血壓達(dá)標(biāo)率≥75%組相比,血壓達(dá)標(biāo)率25%組出現(xiàn)預(yù)后不良的危險(xiǎn)增加了5.287倍,具有統(tǒng)計(jì)學(xué)意義(P0.05)。5腦梗死急性期血壓達(dá)標(biāo)程度與30天預(yù)后分析:單因素logisitic回歸分析,與血壓達(dá)標(biāo)率≥75%組相比,血壓達(dá)標(biāo)率25%組出現(xiàn)預(yù)后不良的危險(xiǎn)增加了1.697倍,血壓達(dá)標(biāo)率25%~50%組出現(xiàn)預(yù)后不良的危險(xiǎn)性增加了1.670倍,具有統(tǒng)計(jì)學(xué)意義(P0.05);多因素logisitic回歸分析,調(diào)整年齡、高血壓病史、糖尿病病史、血糖、發(fā)病前服用降壓藥物、降壓治療、入院NIHSS評(píng)分后,血壓達(dá)標(biāo)程度與30天預(yù)后不良發(fā)生不具有統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論1腦梗死急性期血壓達(dá)標(biāo)率高可降低14天死亡或生活依賴的風(fēng)險(xiǎn)。2腦梗死急性期血壓達(dá)標(biāo)未明顯降低30天死亡或生活依賴的風(fēng)險(xiǎn)。
[Abstract]:Objective to investigate the effect of blood pressure standard on short-term prognosis in acute cerebral infarction. Methods according to the inclusion criteria, 247 patients with first episode acute cerebral infarction who were hospitalized in the Affiliated Hospital of North China University of technology from January 2014 to December 2014 were selected. 42 times of blood pressure were measured from first to 14 days after admission. The standard of blood pressure is defined as less than 140/90mm Hg and greater than 90/60mm Hg. The number of the total percentage of blood pressure standard blood pressure measurement of the total number of points is the standard rate of blood pressure, according to the standard rate of 400, according to the method, the research object will be divided into standard rate of 25% group (54 cases), the standard rate of 25%~50% group (51 cases), the standard rate of 50%~75% group (64 cases) and the compliance rate of more than 75% group (78 cases). The follow-up record for 14 days and 30 days of the US National Institutes of Health Stroke Scale (NIHSS), using Modified Rankin self-care scale (m RS) as prognostic criteria, using univariate and multivariate logisitic regression analysis to observe the effect of blood pressure on short-term prognosis. The results of the 1 general exposure group compared with statistical significance before admission admission taking antihypertensive drugs, after antihypertensive treatment difference (P0.05); the difference was statistically significant in each exposure group history comparison of the history of hypertension (P0.05); the clinical and biochemical indexes of exposed group were not statistically different (P0.05). The scores of NIHSS and NIHSS in the 24 groups were statistically different (P0.05), and there was no statistical difference between the admission and the 14 days of the NIHSS score (P0.05). The NIHSS scores and NIHSS scores at the time of admission were statistically different between the 34 groups (P0.05), and there was no statistical difference between the admission and the 30 days of the NIHSS score (P0.05). 4 acute cerebral infarction and the degree of blood pressure 14 day prognosis analysis: single factor logisitic regression analysis, and the standard rate of blood pressure of more than 75% groups, the standard rate of blood pressure risk of poor prognosis of 25% groups increased by 1.288 times, the standard rate of blood pressure in 25%~50% group the risk of poor prognosis was increased by 1.576 times, with statistical significance (P0.05); logisitic regression analysis, adjusted for age, hypertension, diabetes, blood glucose, before the onset of taking antihypertensive drugs, antihypertensive treatment, admission NIHSS score, and the standard rate of blood pressure of more than 75% groups, the standard rate of blood pressure risk of poor prognosis of 25% groups increased by 5.287 times, with statistical significance (P0.05). 5 acute cerebral infarction and the degree of blood pressure 30 day prognosis analysis: single factor logisitic regression analysis, and the standard rate of blood pressure of more than 75% groups, the standard rate of blood pressure risk of poor prognosis of 25% groups increased by 1.697 times, the standard rate of blood pressure in 25%~50% group the risk of poor prognosis with the increase of 1.670 times, with statistical significance (P0.05); logisitic regression analysis, adjusted for age, hypertension, diabetes, blood glucose, before the onset of taking antihypertensive drugs, antihypertensive treatment, admission NIHSS score, blood pressure level and 30 day prognosis had no statistically significant difference (P0.05). Conclusion the high rate of blood pressure in the acute phase of 1 cerebral infarction can reduce the risk of death or life dependence by 14 days. 2 the risk of blood pressure at the acute stage of cerebral infarction did not significantly reduce the risk of death or life dependence by 30 days.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R743.3

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