急性脑梗死溶栓后24h血压与出血转化及神经功能预后的相关性研究

A Study on the correlation between blood pressure and hemorrhagic transformation as well as neurological function prognosis 24 hours after thrombolysis in acute ischemic stroke

目的分析急性脑梗死溶栓后24 h血压与出血转化及神经功能预后的相关性。方法回顾性纳入221例2018年至2021年于宁德师范学院附属宁德市医院接受纤维蛋白溶酶原激活剂(rt-PA)溶栓治疗的急性脑梗死患者。根据患者溶栓后是否发生出血转化分为出血转化组(36例)和非出血转化组(185例)。所有患者治疗后接受2年以上随访。收集患者的一般人口统计学资料,入院时NIHSS评分和GCS评分以及术前既往史和用药情况。比较两组患者溶栓治疗24 h后的血压变化,包括最大收缩压、平均收缩压、最大舒张、平均舒张压以及舒张压连续变异度(DBPsv)和收缩压连续变异度(SBPsv)。采用Logistic回归分析血压连续变异对出血转化以及神经功能预后的影响。构建了3个回归模型,在模型1中没有校正协变量;在模型2中校正了年龄与性别;在模型3中校正了年龄、性别、糖尿病和高脂血症。最后将血压连续变异程度根据的中位数分为4个水平(Q1~Q4),评估不同水平情况对出血转化以及神经功能预后的影响,同时进行趋势检验。结果在3组模型中,SBPsv对出血转化的OR(95%CI)值分别为1.85(1.58~4.59),1.65(1.30~2.11)和1.66(1.21~2.28)。DBPsv对出血转化的OR(95%CI)值分别为2.34(1.58~4.59),1.65(1.30~2.12)和1.53(1.05~1.67)(P<0.05)。SBPsv对神经功能预后不良OR(95%CI)值分别为1.05(1.03~1.27),1.71(1.08~1.94)和1.19(0.60~2.34)。DBPsv对出血转化的OR(95%CI)值分别为1.13(1.05~1.59),1.29(1.09~2.55)和1.01(0.09~1.26)(P<0.05)。结论血压变异与急性脑梗死静脉溶栓术后患者出血转化的发生以及神经功能预后密切相关,在溶栓治疗过程中动态监测患者血压对于评估病情具有指导作用。

Objective To analyze the correlation between blood pressure 24 hours after thrombolysis for acute ischemic stroke and hemorrhagic transformation and neurological functional prognosis.Methods A retrospective review was conducted on 221 patients with acute ischemic stroke who received recombinant tissue plasminogen activator(rt-PA)thrombolytic therapy at our hospital from 2018 to 2021.Patients were divided into hemorrhagic transformation group(36 cases)and non-hemorrhagic transformation group(185 cases)based on whether they developed hemorrhagic transformation after thrombolysis.All patients were followed up for more than 2 years after treatment.General demographic data,NIHSS score and GCS score at admission,as well as past medical history and medication use before surgery were collected.Blood pressure changes 24 hours after thrombolytic therapy were compared between the two groups,including maximum systolic blood pressure,mean systolic blood pressure,maximum diastolic blood pressure,mean diastolic blood pressure,diastolic blood pressure standard deviation(DBPsv),and systolic blood pressure standard deviation(SBPsv).Logistic regression analysis was used to evaluate the effect of blood pressure variability on hemorrhagic transformation and neurological function prognosis.Three regression models were constructed,with model 1 not adjusting for covariates,model 2 adjusting for age and gender,and model 3 adjusting for age,gender,diabetes,and hyperlipidemia.Finally,the degree of blood pressure variability was divided into four levels(Q1~Q4)based on the median,and the effect of different levels on hemorrhagic transformation and neurological function prognosis was evaluated,while conducting a trend test.Results In the three models,the OR(95%CI)values of SBPsv for hemorrhagic transformation were 1.85(1.58~4.59),1.65(1.30~2.11),and 1.66(1.21~2.28),respectively.The OR(95%CI)values of DBPsv for hemorrhagic transformation were 2.34(1.58~4.59),1.65(1.30~2.12),and 1.53(1.05~1.67),respectively(all P<0.05).The OR(95%CI)values of SBPsv for poor neurological functional prognosis were 1.05(1.03~1.27),1.71(1.08~1.94),and 1.19(0.60~2.34),respectively.The OR(95%CI)values of DBPsv for poor neurological functional prognosis were 1.13(1.05~1.59),1.29(1.09~2.55),and 1.01(0.09~1.26),respectively(all P<0.05).Conclusion Blood pressure variability is closely related to the occurrence of hemorrhagic transformation and neurological function prognosis in patients with acute ischemic stroke after intravenous thrombolysis.Dynamic monitoring of blood pressure during thrombolytic therapy can provide guidance for evaluating the patient's condition.