在院外急救环境中，意识障碍患者的收缩压与卒中之间存在关联。
An association between systolic blood pressure and stroke among patients with impaired consciousness in out-of-hospital emergency settings.
机构信息
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-5 Yamada-oka, Suita, Osaka 565-0871, Japan.
出版信息
BMC Emerg Med. 2013 Dec 17;13:24. doi: 10.1186/1471-227X-13-24.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
Elevated SBP among emergency patients with impaired consciousness in the field was associated with increased diagnosis of stroke.
背景
意识障碍的脑卒中患者难以诊断。但很少有研究探讨院外急救环境下脑卒中的临床预测因素。本研究旨在评估急救医疗服务（EMS）测量的初始收缩压（SBP）值与昏迷患者脑卒中诊断之间的关系。
方法
我们纳入了 1998 年 1 月 1 日至 2007 年 12 月 31 日期间，在日本大阪市（270 万人口）接受 EMS 治疗和转运，且意识障碍（日本昏迷量表≧1）的年龄在 18 岁或以上的所有患者。EMS 人员使用特定的病例报告表前瞻性收集数据。多变量逻辑回归评估了初始 SBP 与卒中及其亚型之间的关系，并针对可能的混杂因素进行了调整。
结果
在这 10 年期间，大阪市共记录了 1840784 名接受 EMS 治疗和转运的急诊患者。在 128678 名意识障碍患者中，有 106706 名患者在现场测量了院前 SBP，符合我们的分析条件。严重意识障碍患者的比例从 SBP<100mmHg 组的 14.5%显著增加到 SBP≥200mmHg 组的 27.6%（趋势 P<0.001）。随着 SBP 的升高，卒中的发生率显著增加（校正优势比[OR] 1.34，95%置信区间[CI] 1.33-1.35），SBP≥200mmHg 组与 SBP 101-120mmHg 组的校正 OR 为 5.26（95%CI 4.93-5.60）。SBP≥200mmHg 组与 SBP 101-120mmHg 组相比，蛛网膜下腔出血（SAH）的校正 OR 为 9.76，颅内出血（ICH）为 16.16，缺血性卒中（IS）为 1.52，SAH 和 ICH 的校正 OR 大于 IS。
结论
现场意识障碍的急救患者 SBP 升高与卒中诊断增加有关。
Zotero 插件