溶栓期血压变化与缺血性脑卒中患者溶栓疗效及预后的关系

Relationship between blood pressure variation during thrombolysis and the curative effect and prognosis of patients with ischemic stroke

目的探讨溶栓期血压变化与缺血性脑卒中(AIS)患者溶栓疗效及预后的关系。方法选取2019年6月至2021年3月在衢州市中医医院接受静脉溶栓治疗的107例AIS患者为研究对象,溶栓期间密切监测血压。分析影响溶栓疗效的因素,比较不同血压水平患者溶栓预后。结果溶栓后90 d后,改良Rankin量表评分判定溶栓有效63例,溶栓无效44例。溶栓有效组患者基线美国国立卫生研究院卒中量表(NIHSS)评分、发病至溶栓时间、高血压比例、基线收缩压、平均收缩压、溶栓24 h收缩压变化值、溶栓24 h舒张压变化值均明显低于溶栓无效组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,基线NIHSS评分(OR=1.878)、发病至溶栓时间(OR=19.893)、平均收缩压(OR=1.157)、溶栓24 h收缩压变化值(OR=2.039)是影响溶栓疗效的主要因素(均P<0.05)。根据患者溶栓24 h内平均舒张压和平均舒张压情况,判定血压过高33例,血压正常74例。血压过高组患者颅内出血、主要不良心血管事件发生率均明显高于血压正常组(均P<0.05);而两组患者脑卒中复发率、全因死亡率比较,差异均无统计学意义(均P>0.05)。结论AIS患者溶栓期血压过高、血压波动幅度过大可影响溶栓疗效及预后,应加强溶栓期血压管理。

Objective To investigate the relationship between blood pressure variation during thrombolysis and the curative effect and prognosis of patients with ischemic stroke(AIS).Methods A total of 107 AIS patients with acute ischemic stroke admitted to Quzhou Hospital of Traditional Chinese Medicine from June 2019 to March 2021 were selected,all patients received intravenous thrombolysis.Blood pressure was closely monitored during thrombolytic therapy.The factors affecting thrombolytic efficacy were analyzed and the prognosis of patients with different blood pressure levels was compared.Results Ninety days of thrombolysis,63 patients were found to be effective and 44patients as ineffective by modified Rankin scale.The baseline NIHSS score,time from onset to thrombolysis,hypertension proportion,baseline systolic blood pressure,mean systolic blood pressure,24 h systolic blood pressure change and 24 h diastolic blood pressure change in effective group were significantly lower than those in ineffective group(all P<0.05).Multivariate logistic regression analysis showed that baseline NIHSS score(OR=1.878),time from onset to thrombolysis(OR=19.893),mean systolic blood pressure(OR=1.157)and 24 h systolic blood pressure change(OR=2.039)were the main factors affecting the efficacy of thrombolysis(all P<0.05).According to the mean diastolic blood pressure and the mean diastolic blood pressure within 24 hours of thrombolysis,33 patients had high blood pressure and 74 patients had normal blood pressure.The incidence of intracranial hemorrhage and major adverse cardiovascular events in hypertensive group was significantly higher than those in normotensive group(all P<0.05),and there was no significant difference in the recurrence rate of stroke and all-cause mortality between the two groups(all P>0.05).Conclusion High blood pressure and excessive blood pressure fluctuation during thrombolysis can affect the efficacy and prognosis of thrombolytic therapy,and blood pressure management during thrombolysis should be strengthened.