Study On The Effect Of Blood Pressure And Its Control On Prognosis After Intracerebral Hemorrhage

Objective:To explore the 14-day survival of ICH patients.To analyze the influencing factors of 14-day survival in ICH patients.To investigate the relationship between blood pressure changes within 14-day,blood pressure control measures and prognosis of ICH patients.Comparing the prognosis of patients with different blood pressure at admission and different blood pressure control programs.To provide scientific basis for developing a reasonable ICH blood pressure control program and improving prognosis.Methods:Selecting acute ICH patients who visited the Department of Neurology at the First Clinical Hospital,Jilin University from January 2004 to December 2006.A total of 786 acute ICH patients met the inclusion exclusion criteria.Collecting basic information,disease history,condition of ICH,laboratory tests on admission,and treatment.Epidata3.1 was used for data entry and R 3.4.3 statistical software was used for statistical analysis of the data.Categorical variables were described by frequency and composition ratio(or rate),and continuous variables were described by `x ± S or M(IQR).K-means algorithm was used to cluster analysis based on SBP and DBP within 14 days.Univariate analysis of 14-day survival in patients with ICH was using COX regression and Log-rank method.Further,multi-factor COX Regression was used to screen independent factors of 14-day survival of ICH patients.The combination of longitudinal and survival data models was used to analyze the factors that influence the 14-day survival of patients with ICH.Statistical significance was set at ? < 0.05.Results:(1)During the follow-up period,70 cases of acute ICH patients died(8.91%),and the average survival time was 13.13(12.92 ~ 13.34)days.(2)The cluster analysis of kmeans algorithm showed that the ICH patients were divided into two groups according to the change of SBP within 14 days.The SBP change rates at 1-2 d and 2-3 d were significantly different in different populations(P<0.001);ICH patients were divided into two groups according to the change of DBP within 14 days.The rate of DBP change at 1-2 d and 2-3 d in different populations was statistically significant(P<0.001).(3)The multivariate COX regression analysis showed that age,24 h NIHSS score,bleeding amount,blood glucose,LDL,ALB,fasting,bleeding site,and changes in SBP were independent influencing factors in 14-day survival of patients with acute ICH(P <0.05).Regarding to age,every 1 year increase in ICH patients,the risk of death within 14 days increased by 1.05(1.03 to 1.08)times.Regarding to the NIHSS score,for every 1 point increase in ICH patients,the risk of death within 14 days increased by 1.13(1.08 to 1.18)times.Regarding to the amount of blood loss,for every 1 m L increase in ICH patients,the risk of death within 14 days increased by 1.06(1.04 to 1.08)times.Regarding to blood glucose levels,for each 1 mmol/L increase in ICH patients,the risk of death within 14 days increased by 1.14(1.05 to 1.24)times.Regarding to LDL levels,for every 1 mmol/L increase in ICH patients,the risk of death within 14 days increased by 1.47(1.07 to 2.01)times.Regarding to ALB levels,the risk of death within 14 days increased by 1.04(1.02 to 1.06)times for every 1 g/L increase in ICH patients.The risk of death within 14 days of fasting ICH patients was 2.82(1.66 to 4.79)times that of patients who were not fasting.Compared with ICH patients with hemorrhagic basal ganglia,the risk of death within 14 days of ICH patients with cerebellar hemorrhage,brainstem hemorrhage,gyrus hemorrhage,or bleeding in other sites was 6.62(1.46~29.98),12.71(5.44~29.70),2.58(1.38~4.83),7.47(3.53~15.78)times respectively.The risk of death within 14 days of SBP-impaired ICH patients was 1.71(1.02 to 2.86)times that of patients with stable SBP.(4)The combination of longitudinal and survival data models found that SBP showed a decreasing trend in patients with ICH over time(P<0.001);antihypertensive drugs and SBP were positively correlated(P<0.001),and antihypertensive drugs interacted with time(P<0.001).The use of antihypertensive drugs can reduce the probability of death in patients with ICH(P = 0.031).Conclusions:(1)In the study,the mortality rate of ICH patients within 14 days was 8.91%,and the average survival time of patients was 13.13(12.92 ~ 13.34)days;(2)age,24 h NIHSS score,bleeding amount,blood glucose,LDL,ALB,fasting,bleeding site,and changes in SBP were independent influencing factors in 14-day survival of patients with acute ICH;(3)With the passage of time,the SBP of patients with ICH showed a decreasing trend;The use of antihypertensive drugs has a stable effect on the SBP level of ICH patients,and at the same time reduce the probability of death in ICH patients;(4)For ICH patients,blood pressure should be lowered as soon as possible,and the SBP blood pressure reduction range within 72 h should be no more than 7mm Hg.