【作者】 杨静；

【导师】 吴丽娥；

【作者基本信息】 内蒙古科技大学包头医学院 ， 临床医学（专业学位）， 2015， 硕士

【摘要】 目的1.明确缺血性脑卒中急性期血压水平与预后的关系;2.探讨影响缺血性脑卒中预后的不同因素。方法2011年10月~2014年4月分别收集包头医学院第一、第二、第三、第四附属医院和包钢医院入住的发病时间在24小时之内的且有明确影像学依据的缺血性脑卒中患者1150例,并根据患者入院时的血压情况进行降压治疗或不进行降压治疗,测量并记录患者血压水平。入组的缺血性脑卒中患者急性期血压水平分为4组:<140 mmHg,(140-159)mmHg,(160-179)mmHg,≥180 mmHg。测量并记录血压水平,出院后3月、6月对患者进行随访,记录发病3月、6月死亡、残疾及复发情况,评估血压水平对患者预后的影响。结果1.缺血性脑卒中患者血压在入院1天内小幅度上升,入院2-5天内缓慢下降,入院6-7天内趋于稳定;2.血压<l40mmHg、(160-179)mmHg、≥180mmHg与血压水平(140-159)mmHg比较,六个月死亡/残疾率的OR值分别是1.982、1.782和3.125;血压<l40mmHg、(160-179)mmHg、≥180mmHg六个月的复发率危险性分别是血压水平(140-159)mmHg的2.118倍、1.739倍和1.919倍;3.TOAST分型死亡/残疾率比较,大动脉粥样硬化(LAA)型患者,血压在160-179mmHg组时死亡/残疾危险最低为0.376,与其他血压组比较有统计学差异(P<0.05);心源性栓塞型(CE),其他各组血压死亡/残疾率危险分别是血压<l40mmHg组的3.244倍、2.091倍和2.300倍;小动脉硬化型(SAO),其他各组血压死亡/残疾率危险性分别是血压<l40mmHg的0.937倍、0.837倍、1.160倍(P>0.05);4.年龄、高血压、吸烟以及总胆固醇可以增加缺血性脑卒中患者的死亡/残疾率,OR为4.233、2.597 1.095和1.644,差异有统计学意义(P<0.05);卒中史、吸烟、高血压、总胆固醇可以增加缺血性脑卒中患者的复发率,OR为2.72、3.37、1.95和1.50,差异有统计学意义(P<0.05)。结论1.缺血性脑卒中急性期血压呈现先升后降的变化规律;2.缺血性脑卒中急性期血压水平与预后呈U型关系。血压在140-159mmHg水平时预后最好,在小于140mm Hg或者大于159mmHg时死亡/残疾率及复发率都会增加;3.不同病因的缺血性脑卒中急性期血压水平控制不同预后不同。在TOAST分型中,LAA亚型血压在160-179mm Hg水平预后最好,在<140mmHg血压水平时预后最差;CE亚型在<140mmHg血压水平时预后最好,在≥180mmHg血压水平时预后最差;SAO亚型在不同血压水平时预后相似,无明显差异;4.年龄、高血压、高胆固醇、吸烟是影响缺血性脑卒中患者预后的主要危险因素。更多还原

【Abstract】 Objective 1.To investigate the blood pressure variation and the relationship between blood pressure levels and prognosis in patients with actue ischemic stroke.2.To study the different factors effecting the prognostic of ischemic stroke patients.Method The 1150 cases of ischemic stroke patients were admitted from the First,Second,Third and Fourth Affiliated Hospital of Baotou Medical College in October 2011 to April 2014,which basis the onset time within 24 hours and a clear imaging.According to blood pressure values??or without antihypertensive treatment,it was measured blood pressure in the hospital.In accordance with China Stroke guide line,the blood pressure levels divided into four groups,such as SBP<140mmHg,140 mmH ≤ SBP<159mm Hg,160 mmHg ≤SBP<179mmHg,SBP≥180mmHg.To measure blood pressure every 8 hours within 7days in the hospital and at least three times and study the death/disability rate and relapse rate of 3,6month,it was assess the prognosis of ischemic stroke patients.Results 1.The blood pressure rises modestly on first day,it was declined slowly on second to firth day and stabilizes on sixth to seventh day in patients with ischemic stroke.2.The compared with blood pressure <l40mmHg,160-179 mmHg and 180 mmHg between140-159 mmHg,there are respectively in Six months of death / disability or values of relative riskwas 1.982,1.782 and 3.12.The six months recurrence rate risk of blood pressure <l40mm Hg,(160-179)mm Hg,is equal to or larger than 180 mmhg six months were respectively the times 2.118、1.739 and 1.919 in the level of blood pressure(140-159)mmHg,3.According to TOAST the relative risk of death/disability rate was 0.376 in LAA subtype patients when blood pressure is 160-179 mmHg,which were statistically significant differences compared with other blood pressure groups(P<0.05).The relative risk of death/disability rate in CE subtype and other blood group is 3.244,2.091,and 2.300 times than blood pressure of 140-159 mmHg.The relative risk of death/disability rate in SAO subtype and other blood group are 0.937,0.837,and1.160 than blood pressure of140-159 mmHg,which were statistically significant differences(P<0.05).4.It is may increase death/disability rate of ischemic stroke patients in age,hypertension,smokingand total cholesterol,which the relative risk are 4.233,1.955,1.095 and 1.644 times and the difference is statistically significant(P<0.05).The recurrence rate of ischemic stroke can increase in family history of stroke,history of smoking,hypertension and high cholesterol,which the relative risk is 2.72,3.37,1.95 and 1.5times and the difference is statistically significant(P<0.05).Conclusions 1.The variation of blood pressure in ischemic stroke patients presents are rising and then decrease.2.Acute blood pressure levels and prognosis in patients with ischemic stroke is U-Shaped relationship,the best prognosis is blood pressure 140-159 mmHg.Different causes of ischemic stroke patients prognosis is differ from at different levels of blood pressure.In TOAST types,the best prognosis is blood pressure 160-179 mmHg in LAA subtype and the worst prognosis is blood pressure <140mmHg.The best prognosis is blood pressure <140mmHg in CE subtype,the worst prognosis is blood pressure ≥180mmHg.The prognosis at different blood pressure of SAO subtype is similar.5.It is major risk factors for prognosis of ischemic stroke patients in age,hypertension,high cholesterol and smoking are.更多还原