An association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings.
An association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings.
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DOI：
10.1186/1471-227x-13-24
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发表时间：
2013-12-17
影响因子：
2.5
通讯作者：
Shimazu T
中科院分区：
文献类型：
--
作者：
Irisawa T;Iwami T;Kitamura T;Nishiyama C;Sakai T;Tanigawa-Sugihara K;Hayashida S;Nishiuchi T;Shiozaki T;Tasaki O;Kawamura T;Hiraide A;Shimazu T
当意识受到干扰时，中风很难诊断。然而，很少有报道讨论院外急诊环境中中风的临床预测因素。本研究旨在探讨急诊医疗服务（EMS）测量的初始收缩压（SBP）值与脑卒中诊断的关系。我们纳入了1998年1月1日至2007年12月31日在日本大阪市（270万）接受EMS治疗和运送的所有18岁及以上意识受损（日本昏迷量表≧1）的患者。EMS人员使用研究特定病例报告表前瞻性地收集数据。多重逻辑回归评估了初始收缩压与卒中及其亚型之间的关系，并对可能的混杂因素进行了调整。在这10年的研究期间，在大阪市共有1,840,784名急诊患者接受了EMS的治疗和运送。在128,678名意识受损患者中，有106,706名院前现场收缩压测量的患者符合我们的分析。严重意识受损患者比例从<100 mmHg收缩压组的14.5%显著增加到> =200 mmHg收缩压组的27.6%（趋势P <0.001）。卒中发生率随收缩压升高而显著增加（调整奇数比[AOR] 1.34, 95%可信区间[CI] 1.33 ~ 1.35），收缩压> =200 mmHg组与收缩压101 ~ 120 mmHg组的AOR为5.26 （95% CI 4.93 ~ 5.60）。蛛网膜下腔出血（SAH）的AOR为9.76，颅内出血（ICH）的AOR为16.16，缺血性脑卒中（IS）的AOR为1.52，且SAH和ICH的AOR大于IS。意识受损的急诊患者收缩压升高与卒中诊断增加相关。
Stroke is difficult to diagnose when consciousness is disturbed. However few reports have discussed the clinical predictors of stroke in out-of-hospital emergency settings. This study aims to evaluate the association between initial systolic blood pressure (SBP) value measured by emergency medical service (EMS) and diagnosis of stroke among impaired consciousness patients. We included all patients aged 18 years or older who were treated and transported by EMS, and had impaired consciousness (Japan Coma Scale ≧ 1) in Osaka City (2.7 million), Japan from January 1, 1998 through December 31, 2007. Data were prospectively collected by EMS personnel using a study-specific case report form. Multiple logistic regressions assessed the relationship between initial SBP and stroke and its subtypes adjusted for possible confounding factors. During these 10 years, a total of 1,840,784 emergency patients who were treated and transported by EMS were documented during the study period in Osaka City. Out of 128,678 with impaired consciousness, 106,706 who had prehospital SBP measurements in the field were eligible for our analyses. The proportion of patients with severe impaired consciousness significantly increased from 14.5% in the <100 mmHg SBP group to 27.6% in the > =200 mmHg SBP group (P for trend <0.001). The occurrence of stroke significantly increased with increasing SBP (adjusted odd ratio [AOR] 1.34, 95% confidence interval [CI] 1.33 to 1.35), and the AOR of the SBP > =200 mmHg group versus the SBP 101-120 mmHg group was 5.26 (95% CI 4.93 to 5.60). The AOR of the SBP > =200 mmHg group versus the SBP 101-120 mmHg group was 9.76 in subarachnoid hemorrhage (SAH), 16.16 in intracranial hemorrhage (ICH), and 1.52 in ischemic stroke (IS), and the AOR of SAH and ICH was greater than that of IS. Elevated SBP among emergency patients with impaired consciousness in the field was associated with increased diagnosis of stroke.