| Objective1.To investigate the relationship admission blood pressure levels and neurological function degree of acute ischemic and hemorrhagic apoplexy patients, through collect a large sample and multi-center clinical information analysis.2.By taking measures on blood pressure that met the criteria of acut cerebral infarction,To observe acute phase blood pressure variation rule. To investigate the relationship between procedural pressure control and the prognosis of ischemic apoplexyMethods1.A retrospective case-control study of epidemiological methods, the 3231 cases of acute stroke patients for the study form Tai'an,Weifang, Zibo,four hospitals of Neurology, that located three different cities,during January 1st,2000 to November 30th,2008. Acute ischemic and hemorrhagic stroke can be defined from imaging.On specialized training for investigators, the case of a uniform questionnaire designed to collect stroke patients hospitalized within 24 hours of basic personal information, lifestyle information, medical history information, laboratory results on admission blood pressure levels, imaging data and neurological score (NIHSS). Establish a database with EpiDate software, using SPSS13.0 software for statistical analysis. Mean were compared by t test and rate compared by X2 test, the both groups. The NIHSS score is divided into two levels, namely NIHSS<5 (mild), and NIHSS≥5 (severe). Multi Factors in Logistic regression analysis to calculate systolic and diastolic blood pressure levels of different NIHSS≥5 of the odds ratio(OR) and 95%confidence interval(95%CI).2. Using randomized control study of hospitalized,Selected from May 1st, to November 30th,2009 at the Hospital of the PLA 88 hospitalization of 49 patients that met the inclusion criteria of cerebral infarction for the study. Randomly divided into experimental and control groups, the experimental group to take procedural antihypertensive treatment; the control group to take conventional treatment (in principle, take no measure); continuous measure and record blood pressure within 14 days after admission. Collection of patient demographic information, admission blood pressure, admission laboratory data, medical history information and the clinical outcome (NIHSS, MRs) information. Establish a database with EpiDate software, using SPSS13.0 software for statistical analysis. Mean were compared by t test and rate compared byχ2 test, the both groups. The difference were compared between the implementation of antihypertensive therapy on prognosis (14 days,1 month and 3 months when the mortality, NIHSS, MRs) and long-term prognosis effects.Results1. By comparison of the general characteristics of patients with stroke, Both the age and the rate of the male are higher than Ischemic stroke, and patients with high triglycerides(TG), low high-density lipoprotein cholesterol (HDL-C), high density lipoprotein cholesterol ratio(LDL-C), diabetes history rates, coronary heart disease rates and atrial fibrillation history was higher than hemorrhagic stroke group; Hemorrhagic stroke rate of high blood sugar, admission systolic blood pressure(SBP), diastolic blood pressure(DBP) and NIHSS score were higher than ischemic stroke group. And the difference was statistically significant.(1)Ischemic stroke patients admitted to hospital with different blood pressure levels, NIHSS≥5 of the OR values and 95%CI. Adjusting for gender, age circumstances, and the admission SBP<140mmHg were compared, SBP≥180mmHg were NIHSS≥5 of the OR values were statistically significant (P<0.05), NIHSS score≥5 is the risk of SBP<140mmHg of 1.64 times. After adjustment by multiple factors, OR value (1.59) remains statistically signific-ant.With admission DBP<90mmHg as a reference, adjusting for gender, age circumstances, DBP 90-99mmHg and 100-109mmHg in those, the NIHSS≥5 of the OR values were 1.25 and 1.51, outcome were statistically significant (P<0.05). After multivariate adjustment, diastolic blood pressure of 100-109 mmHg who NIHSS> 5 of the OR value (1.34) still has a significant difference (P<0.05).(2) Hemorrhagic stroke patients admitted to hospital with different blood pressure levels, NIHSS> 5 of the OR values and 95%CI. Adjusting for gender, age circumstances, and the admission SBP<140mmHg were compared, SBP≥180mmHg in the 160-179mmHg and the OR were NIHSS≥5 were 2.46 and 2.32, outcome were statistically significant (allP<0.01). And by multi-adjusted, blood pressure levels of all those NIHSS≥5 of the OR values were not statistically significant (all P> 0.05).With admission DBP<90mmHg as a reference, adjusting for gender, age circumstances, DBP≥110mmHg were in the 100-109mmHg and NIHSS≥5 of the OR values were 2.26 and 3.04, outcome were significant differences (all P<0.01). After adjustment by multiple factors, DBP≥110mmHg were NIHSS≥5 of the OR value (3.01) still has a significant difference (P<0.05), there is increasing on NIHSS≥5 with DBP increased risk of a trend (P<0.05).2. Experimental and control group comparison of blood pressure in different time periods:within 72h after admission SBP, DBP fluctuations are obvious, but the overall downward trend, the phenomenon exists in the both group, the control group volatility slightly smaller and no statistically significant difference (P>0.05); acute ischemic and hemorrhagic The variation were significantly different (P<0.05) during 4-7 day groups. especially the systolic blood pressure; The blood pressure were stabilized after 7 days 14 days or at discharge showed no significant difference (P>0.05). The outcome no significant difference on 14 days and one month, MRs, mortality showed (P>0.05); The comparison two groups of 3 monthsNIHSS, MRs were signify-cant differences (P<0.05), and the mortality was no significant difference (P> 0.05).Conclusions1. (1)SBP≥180mmHg and DBP 100-109mmHg at admission were significantly associated with neurological function impairment among acute ischemic stroke patients.(2)DBP>110mmHg at admission was significantly associated with neurological function impairment among acute hemorrhagic stroke patients.2. (1)Antihypertensive therapy of acut cerebral infarction can not improve the prognosis of patients about 14 days and 1 month NIHSS, MRs, mortality. (2)Antihypertensive therapy of acut cerebral infarction can improve the prognosis of patients about 3 month NIHSS, MRs, but not make influnce on 3 months mortality significantlyResearch SignificanceThe research takes ischemic stroke lots of real clinical date on the blood control and prognosis, and applies the acue blood pressure therapy with theoretical basis and evidence-based medical evidence.
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