降压方案对高血压性脑出血患者长期预后的影响

摘要
图/表
参考文献(21)
相关文章 (15)

全文: PDF (473 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探索降压方案对高血压性脑出血（HICH）患者长期预后的影响。方法回顾性选取2017年1月1日至2019年12月31日某三级甲等医院神经外科出院的324 例HICH 患者的病例资料，根据本研究的纳入及排除标准，对符合条件的163 例患者为研究对象进行病例查阅或电话回访，采用mRS 评分进行功能评级。将入组的患者分为预后良好组（mRS＜3 分，72 例）和预后不良组（mRS≥3 分，91 例）。首先采用单因素分析方法探讨影响HICH长期预后的因素，然后再将单因素分析结果中P＜0.2 或接近的因素进一步进行HICH 患者1年预后不良的多因素logistic 回归分析。结果单因素分析结果显示，年龄、饮酒史、入院收缩压（SBP）、住院前合并慢性病、口服降压药（类）、入院格拉斯哥昏迷（GCS）评分、出院GCS 评分、多部位出血、住院后使用抗生素、血肿清除术与HICH 患者预后不良相关，差异有统计学意义（P＜0.05）。采用logistic 回归模型进行多因素分析，结果显示，住院前合并慢性病（β=2.028，OR=7.597，95%CI=2.006～28.775）是HICH 患者预后不良的独立危险因素（P＜0.05），口服降压药（类）（β=-0.889，OR=0.411，95%CI=0.215～0.787）、出院GCS 评分（β=-0.682，OR=0.506，95%CI=0.306～0.834）是HICH患者预后不良的保护因素（P＜0.05），年龄（β=0.054，OR=1.055，95%CI=1.000～1.114）有预测HICH 预后不良的趋势（P=0.05）。结论在控制了患者包括人口学特征的基线水平以及出院GCS 评分、住院前合并慢性病的因素后，本研究发现静脉降压药类别数、静脉降压疗程对于HICH 患者的长期预后无明显影响；使用口服降压药种类越多，患者预后可能越好。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：高血压性脑出血, 血压, 降压药, 预后

Abstract：Objective To explore the influence of antihypertensive regimen on the long-term prognosis of patients with hypertensive intracerebral hemorrhage (HICH).Methods The case data of 324 patients with HICH discharged from Department of Neurosurgery of a class Ⅲhospital from January 1,2017 to December 31,2019 were retrospectively selected.According to the inclusion and exclusion criteria of this study,163 eligible patients were reviewed or followed up by telephone.The functional rating was performed with the modified Rankin Scale (mRS).The patients were divided into the good prognosis group (mRS＜3 points,72 cases) and the poor prognosis group (mRS≥3 points,91 cases).Firstly,the factors affecting the long-term prognosis of HICH were discussed by univariate analysis,and then the factors with P＜0.2 or close in the univariate analysis results were further analyzed by multivariate logistic regression analysis.Results Univariate analysis showed that age,drinking history,admission systolic blood pressure (SBP),chronic diseases before hospitalization,oral antihypertensive drugs (classes),Glasgow coma score (GCS) after admission,GCS score after discharge,multiple bleeding,history of antibiotic use after hospitalization and history of hematoma removal were significantly correlated with the poor prognosis of HICH patients,the differences were statistically significant (P＜0.05).Multivariate analysis by logistic regression model showed that there were chronic diseases before hospitalization (β=2.028,OR=7.597,95%CI=2.006-28.775) was an independent risk factor for poor prognosis in patients with HICH (P＜0.05).Oral antihypertensive drugs (class) (β=-0.889,OR=0.411,95%CI=0.215-0.787),discharge GCS score (β=-0.682,OR=0.506,95%CI=0.306-0.834) were protective factor for poor prognosis in patients with HICH (P＜0.05).Age (β=0.054,OR=1.055,95%CI=1.000-1.114) had a tendency to predict the poor prognosis of HICH (P=0.05).Conclusion After controlling the baseline level of patients including demographic characteristics,GCS score at discharge and factors of chronic diseases before hospitalization,this study found that the number of types of intravenous antihypertensive drugs and the course of intravenous administration have no significant impact on the long-term prognosis of HICH patients.The more types of oral antihypertensive drugs are used,the better the prognosis of patients may be.

Key words： Hypertensive intracerebral hemorrhage Blood pressure Antihypertensive drugs Prognosis

引用本文:

王亚飞；卢立山；苏长海. 降压方案对高血压性脑出血患者长期预后的影响[J]. 中国当代医药, 2022, 29(22): 61-65.
WANG Yafei1 LU Lishan2 SU Changhai. Influence of antihypertensive regimen on the long-term prognosis of patients with hypertensive intracerebral hemorrhage. 中国当代医药, 2022, 29(22): 61-65.

链接本文:

https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2022/V29/I22/61

[1]	中华医学会神经外科学分会，中国医师协会急诊医师分会，中华医学会神经病学分会脑血管病学组，等.高血压性脑出血中国多学科诊治指南[J].中华神经外科杂志，2020，36（8）：757-770.
[2]	van Asch CJ，Luitse MJ，Rinkel GJ，et al.Incidence，case fatality，and functional outcome of intracerebral haemorrhage over time，according to age，sex，and ethnic origin：a systematic review and meta-analysis[J].Lancet Neurol，2010，9（2）：167-176.
[3]	BroderickJP，BrottTG，DuldnerJE，etal.Volumeofintracerebral hemorrhage.A powerful and easy-to-use predictor of 30-day mortality[J].Stroke，1993，24（7）：987-993.
[4]	游潮，刘鸣，李浩.脑出血诊治中值得探讨的问题[J].中华神经外科杂志，2013，29（4）：328-329.
[5]	Bath P，Chalmers J，Powers W，et al.International Society of Hypertension （ISH）：statement on the management of blood pressure in acute stroke[J].J Hypertens，2003，21（4）：665-672.
[6]	Anderson CS，Heeley E，Huang Y，et al.Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage[J].N Engl J Med，2013，368（25）：2355-2365.
[7]	Qureshi AI，Palesch YY，Barsan WG，et al.Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage[J].N Engl J Med，2016，375（11）：1033-1043.
[8]	Mehta R，Chinthapalli K.Glasgow coma scale explained[J].BMJ，2019，365：11296.
[9]	Banks JL，Marotta CA.Outcomes validity and reliability of the modified Rankin scale：implications for stroke clinical trials：a literature review and synthesis[J].Stroke，2007，38（3）：1091-1096.
[10]	Kang SJ，Cho YR，Park GM，et al.Predictors for functionally significant in-stent restenosis：an integrated analysis using coronary angiography，IVUS，and myocardial perfusion imaging[J].JACC Cardiovasc Imaging，2013，6（11）：1183-1190.
[11]	Broderick JP，Brott T，Tomsick T，et al.Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage[J].J Neurosurg，1993，78（2）：188-191.
[12]	Koivunen RJ，Satop a a J，Meretoja A，et al.Incidence，risk factors，etiology，severity and short-term outcome of nontraumatic intracerebral hemorrhage in young adults[J].Eur J Neurol，2015，22（1）：123-132.
[13]	AlqahtaniF，OsmanM，HarrisAH，etal.Mortalityandfunctional outcomes of endovascular stroke therapy in the United States[J].Catheter Cardiovasc Interv，2021，97（3）：470-474.
[14]	Kelley RE，Kelley BP.Heart-brain relationship in stroke[J].Biomedicines，2021，9（12）：1835.
[15]	Cai Y，Wang C，Di W，et al.Correlation between blood glucose variability and the risk of death in patients with severe acute stroke[J].Rev Neurol （Paris），2020，176（7-8）：582-586.
[16]	Kimura K，Iguchi Y，Inoue T，et al.Hyperglycemia independently increases the risk of early death in acute spontaneous intracerebral hemorrhage[J].J Neurol Sci，2007，255（1-2）：90-94.
[17]	Hardemark HG，Wesslén N，Persson L.Influence of clinical factors，CT findings and early management on outcome in supratentorial intracerebral hemorrhage[J].Cerebrovasc Dis，1999，9（1）：10-21.
[18]	Juvela S.Risk factors for impaired outcome after spontaneous intracerebral hemorrhage[J].Arch Neurol，1995，52（12）：1193-1200.
[19]	Matis G，Birbilis T.The Glasgow Coma Scale——a brief review.Past，present，future[J].Acta Neurol Belg，2008，108（3）：75-89.
[20]	骆明涛，伍聪，陶传元，等.《高血压性脑出血中国多学科诊治指南》急救诊治解读[J].中国急救医学，2021，41（3）：185-190.
[21]	Broderick J，Connolly S，Feldmann E，et al.Guidelines for the management of spontaneous intracerebral hemorrhage in adults：2007 update：a guideline from the American Heart Association/American Stroke Association Stroke Council，High Blood Pressure Research Council，and the Quality of Care and Outcomes in Research Interdisciplinary Working Group[J].Stroke，2007，38（6）：2001-2023.