脑出血患者超急性期和急性期血压变异度与 90天功能预后的关系

Association between Blood Pressure Variability during Hyperacute and Acute Phases and 90-Day Functional Outcomes in Patients with Intracerebral Hemorrhage

摘要: 目的：本研究旨在探讨自发性脑出血(Intracerebral Hemorrhage, ICH)患者超急性期(发病24小时内)和急性期(发病第2~7天)血压变异度(Blood Pressure Variability, BPV)与90天功能预后的关系，分析不同时间窗内血压波动对远期预后的预测价值，旨在为ICH早期的精细化血压管理提供循证依据。方法：本研究为回顾性分析，连续纳入2022年7月至2024年12月急性ICH患者746例，经过纳入和排除标准筛选后，总计入组138例患者。将患者按发病90天改良Rankin量表(modified Rankin Scale, mRS)评分分为预后良好组(mRS 0~2分) 46例和预后不良组(mRS 3~6分) 42例。分别收集患者超急性期：入院后0、1、6、12、18、24小时和急性期：发病第2~7天，每日早晚的血压数据，计算收缩压(Systolic Blood Pressure, SBP)和舒张压(Diastolic Blood Pressure, DBP)的标准差(Standard Deviation, SD)、变异系数(Coefficient of Variation, CV)、最大–最小差值(Max-Min)及均值(Arithmetic mean, Mean)作为BPV指标。所有患者均在24小时内完成基线头颅CT(Computed Tomography, CT)，并于72小时内复查以评估血肿扩大情况(定义为体积绝对增加>6 mL或相对增加>33%)。采用多因素Logistic回归模型分析BPV与功能预后的独立相关性。结果：多因素Logistic回归分析显示，超急性期血压变异度与90天功能预后显著相关。其中，超急性期较高的SBP Max-Min及DBP CV与ICH患者90天不良预后独立相关。进入急性期后，各项SBP与DBP变异度指标与90天功能预后的独立相关性较弱，未表现出显著的预测价值。结论：自发性脑出血患者发病超急性期的血压变异度是90天不良功能预后的良好预测指标，尤其是SBP极差和DBP变异系数，其预测价值显著高于急性期水平。本研究提示，在ICH发病的极早期，临床不仅应关注降压的绝对目标值，更需高度重视血压的平稳性，尽可能减少剧烈波动以改善患者的远期神经功能结局。

Abstract: Objective: This study aims to investigate the relationship between blood pressure variability (BPV) during the hyperacute phase (within 24 hours of onset) and the acute phase (days 2~7) in patients with spontaneous intracerebral hemorrhage (ICH) and their 90-day functional outcomes. It analyzes the predictive value of blood pressure fluctuations within different time windows for long-term prognosis, with the aim of providing evidence-based support for early individualized blood pressure management in ICH. Methods: This study constitutes a retrospective analysis of a prospective cohort. A total of 746 consecutive patients with acute intracerebral hemorrhage (ICH) admitted between July 2022 and December 2024 were initially identified. Following the application of inclusion and exclusion criteria, 138 patients were ultimately enrolled. Based on their modified Rankin Scale (mRS) scores at 90 days post-onset, patients were categorized into a good prognosis group (mRS 0~2, n = 46) and a poor prognosis group (mRS 3~6, n = 42). Blood pressure data were collected during the hyperacute phase (at 0, 1, 6, 12, 18, and 24 hours after admission) and the acute phase (morning and evening daily from days 2 to 7). The standard deviation (SD), coefficient of variation (CV), maximum-minimum difference (Max-Min), and arithmetic mean (Mean) of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated as BPV parameters. All patients underwent a baseline head computed tomography (CT) within 24 hours and a follow-up CT within 72 hours to evaluate hematoma expansion (defined as an absolute volume increase >6 mL or a relative increase >33%). A multivariate logistic regression model was utilized to analyze the independent correlation between BPV and functional prognosis. Results: Multivariable logistic regression analysis showed that blood pressure variability during the hyperacute phase was significantly associated with 90-day functional outcome. Specifically, higher SBP Max-Min and DBP CV during the hyperacute phase were independently associated with poor 90-day outcome in patients with ICH. In the acute phase, however, the independent associations between SBP and DBP variability indices and 90-day functional outcome were weaker and did not demonstrate significant predictive value. Conclusion: BPV during the hyperacute phase of spontaneous intracerebral hemorrhage serves as a strong predictor of poor functional prognosis at 90 days. In particular, the SBP range (Max-Min) and DBP CV offer a predictive value significantly higher than levels observed in the acute phase. This study suggests that during the very early stages of ICH onset, clinical practice should focus not only on the absolute target values for blood pressure reduction but also highly prioritize blood pressure stability. Severe fluctuations should be minimized as much as possible to improve the long-term neurological outcomes of patients.