血压变异性对老年脑梗死患者早期溶栓疗效的预测价值研究

Predictive value of blood pressure variability for curative effect of early thrombolysis in patients with senile cerebral infarction

目的:探讨血压变异性对老年脑梗死患者(Senile cerebral infarction,SCI)早期溶栓疗效的预测价值。方法:选取2023年1月至2024年3月我院收治的70例SCI患者作为研究对象,所有患者均于发病4 h内进行溶栓治疗,治疗后均接受24 h血压监测,患者根据溶栓效果分为有效组(n=41)和无效组(n=29),比较两组患者临床相关资料、血压变异系数[白天平均收缩压变异系数(Daytime mean systolic blood pressure,dSCV)、夜间平均收缩压变异系数(Nighttime mean systolic blood pressure,nSCV)、白天平均舒张压变异系数(Daytime mean diastolic blood pressure,dDCV)及夜间平均舒张压变异系数(Nighttime mean diastolic blood pressure,nDCV)]以及溶栓前纤维蛋白原水平。观察影响其疗效的因素,分析血压变异系数预测SCI患者早期溶栓疗效的价值。结果:SCI早期溶栓效果与体质量指数(Body mass index,BMI)、有高血压及溶栓前纤维蛋白原水平有关(P<0.05);高血压是影响SCI患者疗效的独立危险因素(P<0.05)。采用倾向匹配法,以“治疗有效”为因变量,“有无高血压,BMI,溶栓前纤维蛋白原水平”为协变量,进行1:1配对病例,排除混杂因子,共得到24对:有效组dSCV、nSCV、dDCV、nDCV系数均低于无效组(P<0.05);受试工作者(Receiver operator characteristic,ROC)曲线面积分析结果显示,dSCV、nSCV、dDCV、nDCV系数及其联合检测均具有预测价值(P<0.05)。结论:SCI早期溶栓效果与BMI、有高血压及溶栓前纤维蛋白原水平有关,高血压是影响SCI早期溶栓疗效的独立危险因素,血压变异异常是导致其疗效不佳的原因,血压变异性系数具有预测SCI患者早期溶栓疗效的价值。

Objective:To explore the predictive value of blood pressure variability for curative effect of early thrombolysis in patients with senile cerebral infarction(SCI).Methods:A total of 70 patients with SCI admitted to the hospital as the research object were enrolled between January 2023 and March 2024.All underwent thrombolysis within 4h after onset and then underwent 24h blood pressure monitoring.According to thrombolysis effect,patients were divided into effective group(n=41)and ineffective group(n=29).The clinical data,blood pressure variation coefficients[daytime mean systolic blood pressure(dSCV),nighttime mean systolic blood pressure(nSCV),daytime mean diastolic blood pressure(dDCV),nighttime mean diastolic blood pressure(nDCV)]and fibrinogen level before thrombolysis were compared between the two groups.The influencing factors of curative effect were observed,the predictive value of blood pressure variation coefficients for curative effect of early thrombolysis in SCI patients was analyzed.Results:The early thrombolysis effect was related to Body mass index(BMI),hypertension and fibrinogen level before thrombolysis(P<0.05).Hypertension was an independent risk factor of curative effect(P<0.05).According to propensity matching method,there were 24 pairs after excluding confounding factors.dSCV,nSCV,dDCV and nDCV in effective group were lower than those in ineffective group(P<0.05).The results of ROC curves analysis showed that dSCV,nSCV,dDCV,nDCV and combined detection were all of predictive value(P<0.05).Conclusion:The early thrombolysis effect is related to BMI,hypertension and fibrinogen level before thrombolysis in SCI.Hypertension is an independent risk factor affecting curative effect of early thrombolysis.Abnormal blood pressure variation is the cause of poor curative effect.The coefficients of blood pressure variability can predict early thrombolysis effect in SCI patients.