静脉溶栓后24 h内血压变化与急性缺血性卒中患者转归的相关性

Correlation between blood pressure changes within 24 h after intravenous thrombolysis and the outcome in patients with acute ischemic stroke

目的探讨静脉溶栓后24 h内血压变化与急性缺血性卒中患者转归的相关性。方法回顾性纳入2018年6月至2020年9月在安徽省第二人民医院神经内科接受阿替普酶静脉溶栓治疗的急性缺血性卒中患者。静脉溶栓治疗前和治疗后24 h内给予降压治疗的患者被排除在外。记录患者静脉溶栓前血压及静脉溶栓后24 h内血压降幅。采用改良Rankin量表评价发病后90 d时的临床转归,0~2分定义转归良好,>2分定义为转归不良。应用多变量logistic回归分析探讨静脉溶栓后24 h内血压变化与临床转归的独立相关性。结果研究纳入205例急性缺血性卒中患者,男性125例(60.98%),女性80例(39.02%);年龄(63.30±9.63)岁,转归良好124例(60.49%),转归不良81例(39.51%)。单变量分析显示,转归良好组糖尿病患者构成比以及基线收缩压、溶栓前血糖、基线美国国立卫生研究院卒中量表评分以及有症状颅内出血发生率较低,小血管闭塞患者的构成比以及溶栓治疗后24 h内收缩压降幅较大(P均<0.05)。多变量logistic回归分析显示,基线收缩压较高与静脉溶栓后90 d转归不良独立相关(优势比0.964,95%置信区间0.942~0.987;P=0.002),静脉溶栓后24 h收缩压降幅较大与转归良好独立相关(优势比1.134,95%置信区间1.067~1.206;P<0.001)。结论对于接受静脉溶栓治疗的急性缺血性卒中患者,静脉溶栓前基线血压与转归不良相关,静脉溶栓后24 h内收缩压降幅与转归良好相关。

Objective To investigate the correlation between blood pressure changes within 24 h after intravenous thrombolysis and the outcome in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke treated with alteplase intravenous thrombolysis in the Department of Neurology,Anhui No.2 Provincial People's Hospital from June 2018 to September 2020 were enrolled retrospectively.The patients who received antihypertensive therapy before and within 24 h after intravenous thrombolysis were excluded.The blood pressure before intravenous thrombolysis and the blood pressure drop within 24 h after intravenous thrombolysis were recorded.The modified Rankin Scale was used to evaluate the clinical outcome at 90 d after the onset.0-2 was defined as good outcome,and>2 was defined as poor outcome.Multivariate logistic regression analysis was used to investigate the independent correlation between blood pressure changes within 24 h after intravenous thrombolysis and the clinical outcomes.Results A total of 205 patients with acute ischemic stroke were enrolled,including 125 males(60.98%),80 females(39.02%);aged 63.30±9.63 years;124(60.49%)had a good outcome,and 81(39.51%)had a poor outcome.Univariate analysis showed that the proportion of diabetic patients as well as baseline systolic blood pressure,prethrombolytic blood glucose,baseline National Institutes of Health Stroke Scale score,and the incidence of symptomatic intracranial hemorrhage in the good outcome group were significantly lower than those in the poor outcome group,and the proportion of patients with small vessel occlusion and the decrease in systolic blood pressure within 24 h after thrombolytic therapy were significantly higher than those in the poor outcome group(all P<0.05).Multivariate logistic regression analysis showed that higher baseline systolic blood pressure was independently associated with the poor outcome at 90 d after intravenous thrombolysis(odds ratio 0.964,95%confidence interval 0.942-0.987;P=0.002),and a greater decrease in systolic blood pressure within 24 h after intravenous thrombolysis was independently associated with a good outcome(odds ratio 1.134,95%confidence interval 1.067-1.206;P<0.001).Conclusion For patients with acute ischemic stroke who received intravenous thrombolysis,higher baseline blood pressure before intravenous thrombolysis was associated with the poor outcome,and greater decrease in systolic blood pressure within 24 h after intravenous thrombolysis was associated with the good outcome.