急性脑梗死患者血压变异性与rt-PA静脉溶栓后近期获益的相关性

Correlation between blood pressure variability and recent benefits of intravenous thrombolysis with rt-PA in patients with acute cerebral infarction

目的探讨急性脑梗死(ACI)患者血压变异性(BPV)与rt-PA静脉溶栓(IVT)治疗后近期获益的相关性。方法回顾性分析2018-11—2021-01安徽医科大学附属宿州医院154例予以rt-PA静脉溶栓治疗的ACI患者的一般资料及相关血清学指标,按溶栓后24 h的神经功能改善率分为近期获益组(≥18%)及近期未获益组(<18%或NIHSS评分增加)。监测患者的24 h动态血压变化情况,计算2组24 h平均收缩压(24hSBP)、白天平均收缩压(dSBP)、夜间平均收缩压(nSBP)、24 h平均舒张压(24hDBP)、白天平均舒张压(dDBP)、夜间平均舒张压(nDBP)、24 h收缩压标准差(24hSSD)、白天收缩压标准差(dSSD)、夜间收缩压标准差(nSSD)、24 h舒张压标准差(24hDSD)、白天舒张压标准差(dDSD)、夜间舒张压标准差(nDSD),24hSSD、24hDSD、dSSD、dDSD、nSSD和nDSD反映BPV,比较2组间各指标。结果近期未获益组患者24hSBP[(145.47±4.75)mmHg vs(143.89±3.85)mmHg]、dSBP[(146.80±6.42)mmHg vs(141.42±3.35)mmHg]、24hSSD[(14.80±1.74)mmHg vs(13.68±1.62)mmHg]、dSSD[(17.89±2.91)mmHg vs(13.89±1.90)mmHg]、nSSD[(8.87±1.70)mmHg vs(8.21±1.54)mmHg]均显著高于近期获益组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示dSBP、dSSD是rt-PA静脉溶栓治疗近期获益的独立影响因素。结论BPV可能是影响IVT患者近期获益的重要因素,且BPV越大,预后可能越差。

Objective To investigate the correlation between blood pressure variability(BPV)and recent benefits of patients with acute cerebral infarction(ACI)after intravenous thrombolysis(IVT)with rt-PA.Methods We conducted a retrospective study on 154 cases of ACI receiving IVT in our hospital between November 2018 and January 2021.According to the neurological improvement rate on 24 h after thrombolysis,the recent curative effect was divided into recent-beneficial group(≥18%)and non-recent-beneficial group(<18%or increased score of NIHSS).The ambulatory blood pressure monitor was used to measure the blood pressure parameters of the patients,figure out 24hSBP,dSBP,nSBP,24hDBP,dDBP,nDBP,24hSSD,dSSD,nSSD,24hDSD,dDSD,nDSD,and 24hSSD,dSSD,nSSD,24hDSD,dDSD,nDSD were used to describe the blood pressure variability,the differences between the two groups were compared.Results Univariate analysis revealed that compared with recent benefit group,the data of non-recent-beneficial group,24hSBP((145.47±4.75)mmHg vs(143.89±3.85)mmHg),dSBP((146.80±6.42)mmHg vs(141.42±3.35)mmHg),24hSSD((14.80±1.74)mmHg vs(13.68±1.62)mmHg),dSSD((17.89±2.91)mmHg vs(13.89±1.90)mmHg),nSSD((8.87±1.70)mmHg vs(8.21±1.54)mmHg),were significantly higher than those of recent benefit group,which had statistically significant differences(P<0.05),and which was a vein influential factors related to the recent benefit.Binary logistic analysis showed that dSBP,dSSD were independent factors affecting recent benefit.Conclusion BPV is likely to be the important factors to predict the recent prognosis of patients with IVT,and the prognosis may be poor if the patients have higher BPV.