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投稿时间：2018-03-09 网络发布日期：2018-09-20
投稿时间：2018-03-09 网络发布日期：2018-09-20
中文摘要: 目的 探讨急性脑梗死血压调控对患者2年预后的影响,为急性脑梗死患者血压长期管理提供治疗方案。方法 选取2014年1月至2015年12月符合入选标准的177例急性脑梗死患者为研究对象,按照随机化原则分为干预组85例和对照组92例,干预组急性期给予降压治疗,对照组急性期原则上不降压(降压治疗的标准:在确保血压在120/80 mm Hg以上的前提下,1天内收缩压下降10％～20％,将血压降至不高于140/90 mm Hg)。分别采用Modified Rankin(mRS)量表和美国国立卫生研究院卒中量表(NIHSS)评估患者2年生活自理能力和神经功能缺损程度,并采用直接计算法计算2年死亡率和排除2年死亡病例后的2年复发率。结果 两组入院时NIHSS评分、mRS评分无统计学差异(P>0.05);在发病2年时,干预组NIHSS评分、mRS评分均低于对照组,且差异有统计学意义(P<0.05)。干预组死亡11例,死亡率为12.9%(11/85),对照组死亡23例,死亡率为25.0%(23/92),两组比较差异有统计学意义(χ2=4.14,P=0.04)。干预组复发17例,复发率为23.0%(17/74),对照组复发34例,复发率为49.3%(34/69),两组比较差异有统计学意义(χ2=10.77,P=0.001)。经多因素Logistic回归分析显示,在调整了年龄、性别、高血压病史、入院时NIHSS评分和收缩压等因素后,急性脑梗死患者给予不同的降压治疗方案均为改善患者2年预后的有利因素(P<0.05)。结论 急性脑梗死患者长期规律合理降压治疗可降低2年死亡和复发的风险,所以在急性脑梗死患者急性期和恢复期均需规律降压治疗。
Abstract:Objective To explore the effects of blood pressure regulation on two-year prognosis of patients with acute cerebral infarction (ACI) and provide a treatment plan for long-term management of blood pressure in ACI patients. Methods A total of 177 ACI patients meeting the inclusion criteria were randomly divided into intervention group (n=85) and control group (n=92). Antihypertensive treatment was given in intervention group (the standard of antihypertensive treatment:under the premise of ensuring the blood pressure above 120/80 mm Hg, the systolic pressure dropped by 10% to 20% within 1 days, and the blood pressure was reduced to no more than 140/90 mm Hg) and wasn't given in control group in principle. The Modified Rankin scale (mRS) and the United States national institutes of health stroke scale (NIHSS)were used to evaluate the two- year self-care ability of life and neurologic function defect degree. A direct calculation method was used to calculate the 2 year mortality rate and the 2-year recurrence rate after excluding the 2 year mortality rate. Results There were no significant differences in NIHSS and mRS on admission between two groups (all P>0.05). At 2 years after disease onset, NIHSS and mRS in intervention group were significantly lower than those in control group (all P<0.05). The mortality rate was 12.9% (11/85)in intervention group and 25.0%(23/92)in control group, there was a statistical difference between two groups (χ2=4.14, P=0.04). The recurrence rate was 23.0% (17/74) in intervention group and 49.3%(34/69)in control group, there was a statistical difference between two groups (χ2=10.77, P=0.001). Multivariate Logistic regression analysis showed that after adjusting the age, sex, hypertension history, admission NIHSS and systolic pressure and other factors, different antihypertensive treatments were beneficial factors to improve the 2-year prognosis in ACI patients. Conclusion The long-term regularity and rational antihypertensive therapy for patients with acute cerebral infarction can reduce the risk of death and recurrence in two years. Therefore, regular antihypertensive therapy is needed in acute and recovery phases of acute cerebral infarction.
文章编号： 中图分类号：R 743.3 文献标志码：B
基金项目:河北省唐山市青年科技拔尖人才项目(14130267b)
引用文本：
陈立稳,王卓,常莉莎,等.急性脑梗死血压调控对患者远期预后的影响[J].中国临床研究,2018,31(9):1260-1263.
陈立稳,王卓,常莉莎,等.急性脑梗死血压调控对患者远期预后的影响[J].中国临床研究,2018,31(9):1260-1263.