摘要：

目的 探讨缺血性卒中急性期平均动脉压对预后的影响。方法 共342 例急性缺血性卒中患者，根据入院时平均动脉压分为< 97 mm Hg 组、97 ~ mm Hg 组、107 ~ mm Hg 组和≥ 117 mm Hg 组，根据改良Rankin 量表（mRS）评分分为预后良好组（mRS < 3 分）和预后不良组（mRS 为3 ~ 6 分），Logistic回归分析评价入院时平均动脉压对发病90 d 时预后的影响。结果 入院时平均动脉压< 97 mm Hg 组、97 ~ mm Hg 组、107 ~ mm Hg 组和≥ 117 mm Hg 组预后不良者分别占34.78%（16/46）、14.29%（14/98）、15.32%（17/111）和41.38%（36/87），以97 ~ mm Hg 组和107 ~ mm Hg 组患者预后更好（均P < 0.01）。Logistic 回归分析显示，入院时平均动脉压为97 ~ 和107 ~ mm Hg 是急性缺血性卒中患者发病90 d 时预后的独立保护因素（P = 0.003，0.011）。结论 急性缺血性卒中患者入院时平均动脉压水平过高或过低均提示预后不良，该项指标可以作为预后预测指标。

关键词: 卒中, 血压, 预后

Abstract:

Objective  To explore the relationship between mean arterial pressure (MAP) on admission and prognosis of patients with acute ischemic stroke.  Methods  A total of 342 patients on acute stage (< 24 h) of ischemic stroke were divided into 4 groups according to their MAP levels on admission: < 97 mm Hg, 97- mm Hg, 107- mm Hg and ≥ 117 mm Hg. Ninety days after onset, these patients were divided into 2 groups according to modified Rankin Scale (mRS): favorable prognosis (mRS < 3) and unfavorable prognosis (mRS 3-6). Logistic regression analysis was used to evaluate the effect of MAP at admission on the prognosis 90 d after onset.  Results Patients with unfavorable prognosis in 4 MAP groups (< 97 mm Hg, 97- mm Hg, 107- mm Hg and ≥ 117 mm Hg) accounted for 34.78% (16/46), 14.29% (14/98), 15.32% (17/111) and 41.38% (36/87), respectively. Patients in 97- mm Hg and 107- mm Hg groups presented better prognosis (P < 0.01, for all). In Logistic regression analysis, by optimal modification of systolic blood pressure (SBP) and diastolic blood pressure (DBP), MAP from 97 mm Hg to 107 mm Hg and from 107 mm Hg to 117 mm Hg were independent protective factors for the prognosis 90 d after onset (P = 0.003, 0.011).  Conclusions  Too high or too low MAP in acute stage of ischemic stroke indicates an unfavorable progonsis of patients. Therefore, MAP can be used as predictive indicator of prognosis of patients with acute ischemic stroke.

Key words: Stroke, Blood pressure, Prognosis