脑卒中患者发生体位性低血压的影响因素探究

关键词：脑卒中  电动起立床  体位性低血压  影响因素

Keywords:stroke  electric standing bed  orthostatic hypotension  influence factor

摘要：

      摘要 目的：探究脑卒中非步行患者发生体位性低血压（orthostatic hypotension， OH）的影响因素，为体位训练中有效防控OH风险提供理论依据。 方法：本研究为横断面研究，纳入2020年6月—2024年3月期间在深圳市第二人民医院和南澳人民医院康复科住院的脑卒中非步行患者为研究对象。收集患者基本信息、疾病情况、临床指标等数据；使用仪器监测并记录患者在电动起立床倾斜0°、30°、60°和80°状态下的血压、心率和血氧饱和度值。统计每个角度下OH的发生情况，采用多因素Logistic回归分析探索OH的影响因素。 结果：共206例患者完成电动起立床倾斜训练，其中男性154例，女性52例，平均年龄60.36岁，OH发生率为24.3%。多因素Logistic回归分析结果发现年龄、血浆纤维蛋白原、尿素和卧位收缩压是脑卒中非步行患者发生OH的独立危险因素。平滑曲线拟合结果发现卧位收缩压、血浆纤维蛋白原含量和尿素水平与OH发生的风险均呈线性关系。按年龄分层分析发现，卧位收缩压、血浆纤维蛋白原值和尿素值升高是60岁以上脑卒中非步行患者发生OH的独立危险因素。按是否卧床进行分层分析发现，尿素值升高是卧床患者发生OH的独立危险因素；年龄增长、饮酒、血浆纤维蛋白原升高和尿素值升高是非卧床患者发生OH的独立危险因素。 结论：随着年龄增长、卧位收缩压升高，以及血浆纤维蛋白原和尿素水平的升高，发生OH的风险可能增加，并且在60岁以上的人群中更为显著。临床上，可以根据这些指标对脑卒中非步行患者进行积极的OH预防，以确保体位训练的安全性。

Abstract:

      Abstract Objective： To explore the influencing factors of orthostatic hypotension（OH） in non-walking patients with stroke， and to provide a basis for the effective prevention and control of OH risk in patients with electric standing bed training. Method： In this cross-sectional study， non-walking stroke patients hospitalized in the rehabilitation departments of Shenzhen Second People's Hospital and Nan'ao People's Hospital between June 2020 and March 2024 were enrolled . Data on patients' basic information， disease conditions， and clinical indicators were collected. Blood pressure， heart rate， and pulse oximetry values were monitored and recorded using an instrument at 0°，30°，60°， and 80°tilts of the motorized elevating bed. The occurrence of OH at each angle was counted，and multifactorial logistic regression analysis was used to explore the influencing factors of OH. Result： A total of 206 patients completed the motorized rising bed tilt training， including 154 males and 52 females， with a mean age of 60.36 years.The incidence of OH was 24.3%. The results of multifactorial logistic regression analysis revealed that age， plasma fibrinogen， urea， and prone systolic blood pressure were independent risk factors for OH occurrence in non-walking patients with stroke. The results of smooth curve fitting analysis found that recumbent systolic blood pressure， plasma fibrinogen content， and urea level were all linearly related to the risk of OH development. Age-stratified analysis found that elevated recumbent systolic blood pressure， plasma fibrinogen value， and urea value were independent risk factors for the development of OH in non-walking patients with stroke aged 60 years or older. Bedridden status-stratified analysis revealed that elevated urea value was an independent risk factor for the development of OH in bedridden patients；while increasing age， alcohol consumption， elevated plasma fibrinogen， and elevated urea values were independent risk factors for the development of OH in non-bedridden patients. Conclusion： The risk of developing OH may increase with increasing age， elevated systolic blood pressure in the prone position， and elevated plasma fibrinogen and urea levels， especially in those over 60 years of age. These indicators can help clinicians actively prevent OH in non-walking patients with stroke to ensure the safety of postural training.