摘要：目的：我们评价脑卒中病人发病时血压水平同早期预后的关系。方法：我们研究了231例脑梗死和265例脑出血病人，研究发病当天入院时血压与发病后30d内死亡率之间的关系。结果：在脑梗死组，血压和死亡率间呈U形关系，收缩压(SBP)在150～169 mmHg，舒张压(DBP)在100～110≥时死亡率最低，在对年龄和性别调整后，相对危险度最高的组是最低血压组。既往有高血压病史的病人，SBP同预后的关系较既往血压正常的病人高10 mmHg。在脑出血组，SBP同死亡率呈J形，DBP同死亡率呈U形，血压最高的组(SBP≥230 mmHg，DBP≥120 mmHg)预后最差。结论：急性脑梗死病人过低或过高的血压和急性脑出血病人过高的血压都会导致差的预后，对有高血压病史者相对高的血压对其预后有利。

    关键词： 脑卒中； 血压； 死亡率

    Effects of Blood Pressure Levels on Case Fatality After Acute Stroke

    ZHANG Hui-qin, LI Da-qiang, GONG Li-ya, et al

    (Dongguan People's Hospital, Guangdong Dongguan 523018, China)

    Abstract: Objective: We evaluated the relationship between admition blood pressure(BP) and early prognosis in patients with acute stroke. Mehtod: Design the subjects comprised 231 cases of brain infarction and 265 cases of brain hemorrhage,who were admitted to hospitals on the day of stroke onset.Death within 30 days after onset was evaluated in relation to admition BP levels.Result: In brain infarction,a U-shaped relationship was found between BP levels and mortality rate,with a nadir at systolic blood pressure(SBP) of 150～169 mmHg,and at diastolic blood pressure (DBP) of 100～110 mmHg.After adjustments for age and sex,the highest relative risks(RR) was observed in the lowest BP levels compared with nadir groups. In subjects with previous hypertension,the relationship between prognosis and SBP level shifted significantly toward higher pressure by about 10 mmHg compared with those without previous hypertension.In subjects with brain hemorrhage,the relationship between BP levels and mortality rate showed a J-shape in SBP and a U-shape in DBP.Highest BP levels had the poorest prognoses(≥230 mmHg in SBP;≥120 mmHg in DBP). Conclusion： Lower and higher BP after brain infarction and higher BP after brain hemorrhage were predictors for poor early prognosis.In subjects with brain infarction,patients with previous hypertension had better outcomes at higher admission BP level than those without hypertension history. ......