急性缺血性卒中静脉溶栓后24h血压变异与早期神经功能恶化的关系

Relationship between blood pressure variability and neurological deterioration occurring within 24h following ischemic stroke with intravenous thrombolysis

目的本研究旨在探索急性缺血性卒中静脉溶栓后24 h血压的变异与早期神经功能恶化的关系。方法回顾性分析2020年1月1日-2020年10月30日在我院就诊的接受静脉溶栓治疗的急性缺血性卒中患者基线临床资料,溶栓后每1 h测量一次血压并记录舒张压和收缩压。血压变异的评估包括:标准差(sd)、连续变异度(sv)。sv为相邻血压差值平方的均值的平方根。早期神经功能恶化定义为:溶栓后24 h内任何一次NIHSS评分(美国国立卫生研究院卒中量表)较静脉溶栓时增加超过4分或死亡。结果最终134例纳入分析。平均年龄(67±13)岁,女性54例(40.3%),NIHSS评分中位数为5(3~9)分,早期神经功能恶化11例(8.2%)。与未发生早期神经功能恶化患者相比,早期神经功能恶化患者收缩压标准差(SBPsd)较大(18 vs 14,t=-2.567,P=0.011),收缩压变异度(SBPsv)较高(22 vs 17,t=-1.988,P=0.049),舒张压标准差(DBPsd)较大(13 vs 9.8,t=-2.431,P=0.016)。将血压变异相关指标(sd、sv)分别纳入二元Logistic回归模型后发现,SBPsd、SBPsv、DBPsd与静脉溶栓后神经功能恶化的独立相关。结论急性缺血性卒中静脉溶栓后血压变异越大,越容易出现24 h内神经功能恶化。

Objective To investigate the impacts of blood pressure(BP)variability on neurological deterioration in patients with acute ischemic stroke after intravenous thrombolysis(IVT).Methods The clinical data of 134 patients after IVT in Department of Neurology,Affiliated Jinhua Hospital,Zhejiang University School of Medicine from January 2020 to September 2020 were retrospectively analyzed,including hour-to-hour BP measurements.BP variability profiles,including average squared difference between successive measurements(sv),standard deviation(sd)were calculated.Early neurological deterioration(END)was defined as the National Institutes of Health Stroke Scale≥4 or death within 24 hour after IVT.The binary logistic-regression model was performed to determine the independent risk factors of END.Results Among 134 patients,with mean age 67 year and median NIHSS 5,11(8.2%)patients achieved END.Compared with non-END group,END group has higher systolic BP sd(18 vs 14,t=-2.567,P=0.011),systolic BP sv(22 vs 17,t=-1.988,P=0.049),diastolic BP sd(13 vs 9.8,t=-2.431,P=0.016).Systolic BP sd,systolic BP sv、and diastolic BP sd were related to the occurring of END independently.Conclusions SP variability is negatively associated with neurological deterioration occurring within 24h following ischemic stroke with intravenous thrombolysis.