急性脑梗死并高血压患者不良事件与静脉溶栓24h内血压管理的相关性研究

Correlation between Adverse Events of Acute Cerebral Infarction Patients Complicated with Hypertension and Blood Pressure Management Within 24 Hours after Intravenous Thrombolysis

背景静脉溶栓24 h内患者血压管理不佳会增加不良事件发生风险,尤其是合并高血压患者。目前各国指南对静脉溶栓后患者的血压管理主要是制定血压控制目标值、血压变异度、降压速率。目的探讨急性脑梗死并高血压患者不良事件发生情况与静脉溶栓24 h内血压管理的相关性,以期为制定个体化的血压管理方案提供参考。方法选取2017年8月至2020年11月广西医科大学第二附属医院神经内科收治的行静脉溶栓的急性脑梗死并高血压患者71例。根据静脉溶栓24 h内的血压控制目标值、血压变异度、降压速率将患者进行分组。比较不同血压管理患者的一般资料及不良事件发生率。采用Spearman秩相关分析探讨急性脑梗死并高血压患者静脉溶栓24 h内血压控制目标值、血压变异度及降压速率与不良事件发生情况的相关性。结果急性脑梗死并高血压患者静脉溶栓24 h内血压控制目标值≥181 mm Hg 18例,161~180 mm Hg 30例,≤160 mm Hg 23例;血压变异度≤20 mm Hg 8例、21~40mm Hg 27例、41~60 mm Hg 21例、≥61 mm Hg 15例;降压速率≤20%16例、> 20%~30%23例、> 30%~40%13例、> 40%19例。静脉溶栓24 h内不同血压控制目标值、血压变异度、降压速率患者不良事件发生率及不同血压变异度患者高脂血症发生率、体质指数(BMI)、入院时美国国立卫生研究院卒中量表(NIHSS)评分比较,差异有统计学意义(P <0.05)。Spearman秩相关分析结果显示,急性脑梗死并高血压患者不良事件发生情况与静脉溶栓24 h内血压变异度(rs=0.259,P=0.029)、降压速率(rs=0.238,P=0.046)呈正相关,与血压控制目标值无线性相关(rs=-0.082,P=0.499)。结论急性脑梗死并高血压患者静脉溶栓24 h内不良事件与血压变异度、降压速率呈正相关,建议将其静脉溶栓24 h内血压变异度控制在≤20 mm Hg,降压速率控制在≤20%。

Background Improper blood pressure control within 24 hours after intravenous thrombolysis may increase the risk of adverse events, especially for the patients with hypertension. The current national guidelines about blood pressure management for the patients after intravenous thrombolysis mainly focus on the formulation of blood pressure control target value, blood pressure variability, and hypotensive rate. Objective To explore the correlation between adverse events of acute cerebral infarction patients complicated with hypertension and blood pressure management within 24 hours after intravenous thrombolysis, in order to provide a reference for formulating individualized blood pressure management plans. Methods From August 2017 to November 2020, 71 acute cerebral infarction patients complicated with hypertension treated with intravenous thrombolysis from the Department of Neurology of the Second Affiliated Hospital of Guangxi Medical University. The patients were grouped by blood pressure control target value, blood pressure variability, and hypotensive rate within 24 hours after intravenous thrombolysis. General information and incidence of adverse events were compared in different groups. Spearman rank correlation analysis was used to investigate the correlation of blood pressure control target value, blood pressure variability, and hypotensive rate within 24 hours after intravenous thrombolysis and occurrence of adverse events in acute cerebral infarction patients complicated with hypertension. Results In acute cerebral infarction patients complicated with hypertension within 24 hours after intravenous thrombolysis, 18 cases of blood pressure control target value ≥ 181 mm Hg, 30 cases of 161-180 mm Hg, 23 cases of ≤ 160 mm Hg;8 cases of blood pressure variability ≤ 20 mm Hg, 27 cases of 21-40 mm Hg, 21 cases of 41-60 mm Hg, 15 cases of ≥ 61 mm Hg;16 cases of hypotensive rate ≤ 20%, 23 cases of > 20%-30%, 13 cases of > 30%-40%, 19 cases of > 40%. There were statistically significant differences of incidence of adverse events of acute cerebral infarction patients complicated with hypertension among different blood pressure control target value, blood pressure variability, and hypotensive rate within 24 hours after intravenous thrombolysis(P < 0.05). There were statistically significant differences in the occurrence of hyperlipidemia, body mass index(BMI), and National Institutes Health Stroke Scale(NIHSS) score at admission of acute cerebral infarction patients complicated with hypertension among different blood pressure variability within 24 hours after intravenous thrombolysis(P < 0.05). The results of Spearman rank correlation analysis showed that the occurrence of adverse events of acute cerebral infarction patients complicated with hypertension was positively correlated with blood pressure variability(rs=0.259, P=0.029) and hypotensive rate(rs=0.238, P=0.046) within 24 hours after intravenous thrombolysis, and was wireless correlated with blood pressure control target value within 24 hours after intravenous thrombolysis(rs=-0.082, P=0.499). Conclusion The occurrence of adverse events of acute cerebral infarction patients complicated with hypertension are positively correlated with blood pressure variability and hypotensive rate within 24 hours after intravenous thrombolysis. It is recommended to control the blood pressure variability ≤20 mm Hg, hypotensive rate ≤20% within 24 hours after intravenous thrombolysis.