急性缺血性脑卒中rt-PA溶栓早期血压波动、血糖变化及与预后的关系

Fluctuation of blood pressure,changes of blood glucose and their relationship with prognosis in acute ischemic stroke during early rt-PA thrombolysis

目的探究急性缺血性脑卒中(AIS)重组组织型纤溶酶原激活剂(rt-PA)溶栓早期血压波动、血糖变化及与预后的关系。方法选取2018年1月2021年12月安阳市第三人民医院收治的rt-PA溶栓早期AIS患者共计62例,根据患者预后情况,将研究对象分为预后良好组(n=39)、预后不良组(n=23);记录两组研究对象血压波动、血糖变化情况,比较收缩压变化标准差(S_(SD))、舒张压变化标准差(D_(SD))、空腹血糖水平标准差(FPG_(SD));收集患者一般资料,先采用单因素分析探究不同因素同AIS患者预后的关系,随后采用Logistic多因素回归分析,探究引起预后不良的独立危险因素。结果预后良好组S_(SD)、D_(SD)水平低于预后不良组(P<0.05);且预后良好组连续5 d FPG以及FPG_(SD)水平均低于预后不良组(P<0.05);单因素回归分析结果显示,美国国立卫生院卒中量表(NIHSS)评分≥10分、S_(SD)≥15.00、D_(SD)≥12.00、FPG_(SD)≥1.4 mmol/L的患者发生预后不良的病例数占比更高(P<0.05);Logistic多因素回归分析结果显示,高水平NIHSS、S_(SD)、D_(SD)、FPG_(SD)是AIS患者预后不良的独立危险因素。结论AIS患者rt-PA溶栓早期血压波动、血糖变化同预后关系密切,监控血压波动、血糖变化对AIS患者预后评估具有显著意义。

【Objective】To explore fluctuation of blood pressure,changes of blood glucose and their relationship with prognosis in acute ischemic stroke(AIS)during early recombinant tissue plasminogen activator(rt-PA)thrombolysis.【Methods】A total of 62 patients with AIS during early rt-PA thrombolysis in the hospital were retrospectively analyzed between January 2018 and December 2021.According to prognosis,they were divided into good prognosis group(n=39)and poor prognosis group(n=23).The changes of blood pressure and blood glucose in both groups were recorded.The standard deviations of systolic blood pressure(S_(SD)),diastolic blood pressure(D_(SD))and fasting blood glucose(FPG_(SD))were compared.The general data of patients were collected.The relationship between different factors and prognosis of AIS patients was explored by univariate analysis,and then the independent risk factors of poor prognosis were explored by Logistic multivariate regression analysis.【Results】S_(SD) and D_(SD) in good prognosis group were significantly lower than those in poor prognosis group(P<0.05),the levels of FPG and FPG_(SD) for 5 consecutive days in the good prognosis group were lower than those in the poor prognosis group,and the differences were statistically significant(P<0.05).Univariate regression analysis showed that patients with National Institutes of Health Stroke Scale(NIHSS)score≥10,S_(SD)≥15.00,D_(SD)≥12.00,and FPG_(SD)≥1.4mmol/L had a significantly higher proportion of poor prognosis(P<0.05).Multivariate Logistic regression analysis showed that high levels of NIHSS,S_(SD),D_(SD) and FPG_(SD) were independent risk factors for poor prognosis in AIS patients.【Conclusion】The changes of blood pressure and blood glucose in the early stage of rt-PA thrombolysis are closely related to the prognosis of AIS patients.Monitoring the changes of blood pressure and blood glucose has significant significance for the prognosis assessment of AIS patients.