本文選題：腦梗死 + 應激性高血壓�。� 參考：《昆明醫(yī)科大學》2017年碩士論文

【摘要】：[目的]研究急性腦梗死伴應激性高血壓患者的血壓變化情況及與30天預后的關系。[方法]選擇2015年3月-2016年11月發(fā)病24小時內(nèi)入院的急性腦梗死患者,將入院患者中符合應激性高血壓診斷標準者納入研究課題,共121例。收集一般臨床資料,監(jiān)測入院10天內(nèi)不同時間點的血壓,分析血壓的變化情況。同時分別在入院時、入院第10天及發(fā)病后30天應用美國國立衛(wèi)生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS 量表)和 Barthel 指數(shù)評定量表(Barthel Index,BI)評價神經(jīng)功能缺損程度和日常生活能力。按照入院時NIHSS量表評分分為低評分組(≤6分)、中評分組(7～14分)、高評分組(≥15分),通過3組患者入院3天內(nèi)平均收縮壓(Mean Systolic Blood Pressure, MSBP)及平均舒張壓(MeanDiastolic Blood Pressure, MDBP)的下降幅度比較,分析神經(jīng)功能缺損程度與血壓變化的關系;按照入院時BI評分分為輕度功能障礙組(60分)、中度功能障礙組(60～41分)、重度功能障礙組(≤40分),通過3組患者入院3天內(nèi)MSBP及MDBP下降幅度比較,分析日常生活能力下降程度與血壓變化的關系;按照入院3天內(nèi)MSBP下降率分為下降率低組(5～10%)、中組(10～15%)和高組(≥15%),同時按照入院3天內(nèi)MDBP下降率分為下降率低組(5～10%)、中組(10～15%)和高組(≥15%),分別分析三組患者MSBP和MDBP下降率與30天NIHSS好轉(zhuǎn)率和BI評分的關系。[結(jié)果]1.對121例急性腦梗死伴應激性高血壓患者入院后不同時間點的收縮壓和舒張壓采用配對t檢驗結(jié)果顯示,入院時MSBP和MDBP分別與入院12h、第1天至第10天血壓比較均有差異(P0.01),入院第8天MSBP和MDBP分別與第9、10天比較,差異無統(tǒng)計學意義(P0.05)。2.按入院時NIHSS評分分組的三組患者,高評分組患者入院時MSBP及MDBP均明顯高于其他兩組;高評分組患者入院3天內(nèi)MSBP下降幅度大于其他兩組患者,中評分組與低評分組患者比較無差異;各組患者入院3天內(nèi)MDBP下降幅度均無差異。3.按入院時BI評分分組的三組患者,重度功能障礙組患者入院時平均收縮壓及平均舒張壓均明顯高于其他兩組;重度功能障礙組患者入院3天內(nèi)MSBP下降幅度大于輕度功能障礙組患者,中度功能障礙患者與其他兩組比較均無差異;各組患者入院3天內(nèi)MDBP下降幅度均無差異。4.按入院3天內(nèi)平均收縮壓下降率分組的三組患者,入院第10天NIHSS好轉(zhuǎn)率無差異;MSBP下降率高組(≥15%)發(fā)病后30天NIHSS好轉(zhuǎn)率低于低組(5～10%),中組(10～15%)與其他兩組均無差異;MSBP下降率高組(≥15%)患者入院第10天及發(fā)病后30天BI評分均低于其他兩組;低組(5～10%)和中組(10～15%)患者入院第10天及發(fā)病后30天BI評分無差異。按入院3天內(nèi)平均舒張壓下降率分組的三組患者,入院第10天及發(fā)病后30天NIHSS好轉(zhuǎn)率及BI評分均無差異。[結(jié)論]1.發(fā)病24h內(nèi)入院的急性腦梗死伴應激性高血壓患者,入院時收縮壓及舒張壓均呈升高趨勢,以收縮壓升高為主,入院后血壓開始逐漸下降,多在入院后3天內(nèi)收縮壓及舒張壓下降幅度最大,入院后第8天血壓逐漸趨于平穩(wěn)。2.重度神經(jīng)功能缺損組患者入院時平均收縮壓及平均舒張壓均明顯高于輕度和中度神經(jīng)功能缺損組,入院3天內(nèi)平均收縮壓下降幅度均大于輕度和中度神經(jīng)功能缺損組患者;未發(fā)現(xiàn)神經(jīng)功能缺損程度與入院3天內(nèi)平均舒張壓下降幅度相關。3.重度日常生活能力障礙組患者入院時平均收縮壓及平均舒張壓均明顯高于輕度和中度日常生活能力障礙組,入院3天內(nèi)平均收縮壓下降幅度大于輕度日常生活能力障礙患者;未發(fā)現(xiàn)日常生活能力下降程度與入院3天內(nèi)平均舒張壓下降幅度相關。4.入院3天內(nèi)平均收縮壓下降率超過15%組的患者30天預后較差;未發(fā)現(xiàn)入院3天內(nèi)平均舒張壓下降率與30天預后相關。5.腦梗死患者急性期應嚴密動態(tài)監(jiān)測血壓變化,謹慎降壓,推薦個體化治療。
[Abstract]:[Objective] to study the changes of blood pressure and the relationship with the 30 day prognosis in patients with acute cerebral infarction with stress hypertension. [Methods] select the patients who were hospitalized for 24 hours in March 2015 -2016 years, and put the standard of stress hypertension into the research subjects, 121 cases were collected, and the general clinical funds were collected. The blood pressure was monitored at different time points within 10 days of admission and the changes of blood pressure were analyzed. At the same time, the National Institutes of Health Stroke Scale (National Institutes of Health Stroke Scale, NIHSS scale) and Barthel index rating scale (Barthel Index, BI) were used to evaluate the nerve work at the admission, tenth days after admission and 30 days after the onset of the disease. According to the admission NIHSS scale, the scores were divided into low rating group (less than 6 points), middle evaluation group (7~14), high rating group (15), and the decrease of mean systolic blood pressure (Mean Systolic Blood Pressure, MSBP) of Ji Ping mean diastolic pressure (MeanDiastolic Blood Pressure, MDBP) in 3 groups of patients within 3 days of admission. The relationship between the degree of nerve function defect and the change of blood pressure was analyzed. According to the BI score at admission, it was divided into the mild dysfunction group (60 points), the moderate dysfunction group (60~41 points), the severe dysfunction group (less than 40 points), and the comparison of the decrease of MSBP and MDBP within the 3 days of admission to the hospital, and the relationship between the decrease of daily living ability and the change of blood pressure. The MSBP decline rate was divided into lower rate group (5 ~ 10%), middle group (10 ~ 15%) and high group (> 15%) in the 3 days of admission. At the same time, the decrease rate was divided into lower rate group (5 ~ 10%), middle group (10 ~ 15%) and high group (> 15%) in 3 days, and the relationship between the decrease rate of MSBP and MDBP and the NIHSS improvement rate and BI score of three patients were analyzed respectively. [results]1. The results of paired t test on systolic and diastolic pressure of 121 patients with acute cerebral infarction with stress hypertension at different time points after admission showed that both MSBP and MDBP were significantly different from 12h, first days to tenth days (P0.01) at admission (P0.01), and there was no significant difference between MSBP and MDBP at the day of admission and 9,10 days respectively (P0.0). 5).2. was significantly higher than the other two groups at the time of admission to the group of three groups. The MSBP and MDBP in the high evaluation group were significantly higher than those of the other two groups. The decrease of MSBP in the high evaluation group was greater than the other two groups within 3 days. There was no difference between the group and the low rating group in the 3 days. The MDBP decline of the patients in each group had no difference of.3. within the 3 days of admission. The average systolic pressure and mean diastolic pressure of the patients with severe dysfunction group were significantly higher than that of the other two groups in the three groups of BI score group. The decrease of MSBP in the patients with severe dysfunction group was greater than that of the mild dysfunction group within 3 days, and the patients with moderate dysfunction had no difference with the other two groups; the patients in each group were admitted to hospital. In 3 days, there was no difference in the decrease of MDBP in the three groups of group.4. according to the average systolic blood pressure drop rate within 3 days of admission, and there was no difference in the improvement rate of NIHSS at the tenth day of admission, and the improvement rate of NIHSS in the high group of MSBP descending (> 15%) was lower than that in the low group (5 to 10%), and the middle group (10 to 15%) was not different from that of his group; the high group of MSBP descending rate (> 15%) was admitted to hospital. Tenth days and 30 days after the onset of BI score were all lower than the other two groups, the lower group (5 ~ 10%) and the middle group (10 to 15%) patients were admitted to hospital for tenth days and 30 days after the onset of the BI score had no difference. According to the average diastolic blood pressure drop rate within 3 days of 3 days in three patients, there was no difference in NIHSS improvement rate and BI score in 30 days after admission and after the onset of disease. [conclusion]1. in the pathogenesis of 24h) The systolic pressure and diastolic pressure of the hospitalized acute cerebral infarction patients with stress hypertension were increased, the systolic pressure increased mainly, the blood pressure began to decrease gradually after admission, and the contraction pressure and diastolic pressure decreased most within 3 days after admission, and the blood pressure gradually tended to stable.2. severe nerve function defect group eighth days after admission. The average systolic pressure and mean diastolic pressure in the hospital were significantly higher than those of mild and moderate neurological deficit groups. The average systolic pressure decreased in 3 days more than those in the mild and moderate neurological deficit groups, and the degree of neural function defect was not associated with the average diastolic pressure drop within 3 days of admission.3.. The average systolic pressure and mean diastolic pressure in the hinder group were significantly higher than those in the mild and moderate daily life ability disorder group. The average systolic pressure dropped more than the mild daily life disability patients within 3 days. The decrease of daily living ability and the average diastolic pressure drop within 3 days of admission were not found to be.4. within 3 days of admission. The 30 day prognosis of the patients with the average systolic blood pressure drop over 15% groups was poor, and the average diastolic blood pressure drop rate in the 3 days of admission and the 30 day prognosis were not found. The acute phase of.5. cerebral infarction should be closely monitored and the blood pressure change should be closely monitored, and the individual treatment should be recommended carefully.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3;R544.1

【參考文獻】

相關期刊論文 前10條

1 韓亞男;;腦梗死患者急性期降壓治療對腦梗死預后的影響[J];中國醫(yī)藥科學;2016年21期

2 姚立巖;楊曉煒;李海紅;李曉霞;高錦;范娜;于思雨;;C反應蛋白與缺血性腦卒中關系的研究進展[J];中國老年學雜志;2016年17期

3 左鳳同;董愛勤;;雙重抗血小板聚集治療缺血性腦卒中[J];腦與神經(jīng)疾病雜志;2016年01期

4 蔡奕秋;周少瓏;周輝;邢愛群;張倩;;老年急性期腦梗死血壓變異性的影響因素及其與預后的相關性[J];中國老年學雜志;2015年08期

5 夏明栓;;阿司匹林聯(lián)合阿托伐他汀鈣對急性腦梗死患者C反應蛋白的影響[J];中西醫(yī)結(jié)合心腦血管病雜志;2015年04期

6 劉力松;;缺血性腦卒中早期血壓的管理[J];中華高血壓雜志;2014年12期

7 楊奕;肖驊;;普羅布考抗動脈粥樣硬化研究新進展[J];醫(yī)學綜述;2014年23期

8 王大力;花楠;彭延波;;腦梗死急性期血壓變化規(guī)律及降壓治療對預后的影響[J];中華流行病學雜志;2014年06期

9 李楊;李長清;;腦卒中急性期的血壓管理研究進展[J];現(xiàn)代醫(yī)藥衛(wèi)生;2014年08期

10 林艷梅;羅東;李涵志;羅韶輝;羅桃英;;中青年腦梗死患者血清UA、hs-CRP水平變化及與頸動脈粥樣硬化斑塊的關系[J];山東醫(yī)藥;2014年15期

，

本文編號：1993611