Zhongguo cuzhong zazhi (Jul 2022)

脑出血急性期不同血压参数与预后的关系 Association of Admission Blood Pressure with Outcome in Cerebral Hemorrhage

  • 宋新杰, 姜睿璇, 张怡君, 王安心, 李子孝, 赵性泉

DOI
https://doi.org/10.3969/j.issn.1673-5765.2022.07.016
Journal volume & issue
Vol. 17, no. 7
pp. 769 – 773

Abstract

Read online

目的 通过中国国家卒中登记Ⅱ（China national stroke registry Ⅱ，CNSRⅡ）的数据，分析入院收缩压（systolic blood pressure，SBP）、舒张压（diastolic blood pressure，DBP）及平均动脉压（mean arterial pressure，MAP）与脑出血患者死亡和功能结局的关系。 方法 收集CNSRⅡ数据库中自发性脑出血患者的人口学信息和临床数据，应用logistic回归分析患者入院时不同SBP分层、SBP、DBP和MAP对患者短期和长期预后（包括院内死亡、3个月死亡及预后不良和1年预后不良）的影响。 结果 共有1048例脑出血患者的资料纳入统计分析，平均年龄62.1±12.5岁，男性666例（63.5%）。入院时平均SBP为162.1±28.9 mmHg，平均DBP为95.1±17.6 mmHg，平均MAP为117.4±20.1 mmHg。与入院SBP 120～139 mmHg的患者相比，入院SBP 180～199 mmHg（OR 17.53，95%CI 2.25～136.66，P=0.0063）和SBP≥200 mmHg的患者（OR 21.74，95%CI 2.74～172.55，P=0.0036）的在院死亡风险均增加。入院SBP每升高10 mmHg，患者在院死亡风险（OR 1.25，95%CI 1.14～1.37，P<0.0001）、3个月预后不良（OR 1.08，95%CI 1.02～1.15，P=0.0066）和死亡风险（OR 1.13，95%CI 1.04～1.22，P=0.0049）均增加。入院DBP每升高10 mmHg，患者在院死亡风险（OR 1.36，95%CI 1.16～1.59，P=0.0001）、3个月预后不良（OR 1.16，95%CI 1.05～1.29，P=0.0034）和死亡风险（OR 1.20，95%CI 1.05～1.38，P=0.0093）均增加。入院MAP每升高10 mmHg，患者在院死亡风险（OR 1.37，95%CI 1.20～1.57，P<0.0001）、3个月预后不良（OR 1.13，95%CI 1.04～1.23，P=0.0044）和死亡风险（OR 1.20，95%CI 1.06～1.35，P=0.0036）均增加。 结论 入院SBP、DBP和MAP水平是脑出血患者院内死亡和3个月预后不良的独立危险因素，但对患者1年预后不良无独立影响。 文章导读： 本研究依托大型、多中心临床研究CNSR II，对急性脑出血患者入院时多种血压参数进行分析，结果显示入院时SBP、DBP、MAP升高均可显著增加患者的短期死亡率和预后不良率，但对发病1年的预后不良影响不显著。 Abstract: Objective To explore the relationship between admission blood pressure (BP) and outcomes in patients with cerebral hemorrhage. Methods This study collected the data of patients with spontaneous intracerebral hemorrhage from the China National Stroke Registry Ⅱ (CNSRⅡ) database. Logistic regression model was used to analyze the relationship between systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and the outcomes (including in-hospital death, 3-month death, 3-month poor prognosis and 1-year poor prognosis), after adjusting for the confounding factors. Results A total of 1048 patients were included in this study, with an average age of 62.1±12.5 years and 666 males (63.5%). At admission, the average SBP was 162.1±28.9 mmHg, the average DBP was 95.1±17.6 mmHg, and the average MAP was 117.4±20.1 mmHg. Compared with patients with SBP 120-139 mmHg at admission, the patients with SBP 180-199 mmHg (OR 17.53, 95%CI 2.25-136.66, P=0.0063) and SBP ≥200 mmHg (OR 21.74, 95%CI 2.74-172.55, P=0.0036) had a higher in-hospital mortality rate. The risk of in-hospital mortality (OR 1.25, 95%CI 1.14-1.37, P<0.0001), 3-month poor prognosis (OR 1.08, 95%CI 1.02-1.15, P=0.0066), and 3-month mortality (OR 1.13, 95%CI 1.04-1.22, P=0.0049) all increased per an increase of 10 mmHg in admission SBP. The risk of in-hospital mortality (OR 1.36, 95%CI 1.16-1.59, P=0.0001), 3-month poor prognosis (OR 1.16, 95%CI 1.05-1.29, P=0.0034), and 3-month mortality (OR 1.20, 95%CI 1.05-1.38, P=0.0093) all increased per an increase of 10 mmHg in admission DBP. The risk of in-hospital mortality (OR 1.37, 95%CI 1.20-1.57, P<0.0001), 3-month poor prognosis (OR 1.13, 95%CI 1.04-1.23, P=0.0044), and 3-month mortality (OR 1.20, 95%CI 1.06-1.35, P=0.0036) all increased per an increase of 10 mmHg in admission MAP. Conclusions Admission SBP, DBP and MAP levels were independent risk factors for in-hospital death and 3-month poor prognosis in patients with intracerebral hemorrhage, but were not associated with 1-year poor prognosis.

Keywords