| Objectives To evaluate the effect of blood pressure regulation on the prognosis of patients with acute severe cerebral infarction,blood pressure regulation was carried out in ASCI patients,and the neurological function,life dependence,good prognosis rate,adverse events and death of patients were observed.Methods A total of 351 acute severe cerebral infarction patients with onset within 48 hours admitted to the Department of Neurointensive Care in the Affiliated Hospital of North China University of Science and Technology from February 2019 to October 2020 were included as research subjects.There were 128 cases in conventional treatment group(anti-platelet aggregation,etc),136 cases in intravenous thrombolysis group(standard dose of alteplase)and 87 cases in bridging group(intravenous thrombolysis + stent thrombolysis).Patients with each treatment regimen were randomly divided into the intervention group(hypotension according to the blood pressure regulation regimen)and the control group(hypotension according to the guidelines).In the intervention group,the blood pressure was regulated to a systolic blood pressure of less than or equal to140 mm Hg but not less than 130 mm Hg,and in the control group,the blood pressure was regulated to a systolic blood pressure of less than 180 mm Hg but not less than 141 mm Hg,and the average daily blood pressure of the patients was recorded.An invasive intracranial pressure monitor was used to monitor intracranial pressure during hospitalization.Neurological function was evaluated using the National Institutes of Health Stroke Scale at admission,7d,14 d,21d and 3 months after admission.Barthel index was used to evaluate the degree of life dependence of the patients at 3 months.The m RS score was used to evaluate the prognosis of patients at 3 months.The safety of blood pressure regulation for patients was evaluated by recording the occurrence of intracranial and other hemorrhage,cerebral hernia during the 14 days of hospitalization.Patients were followed up for death within 90 days.Results 1 After admission,intracranial pressure of the intervention group and the control group had the same trend,which gradually increased within 5 days and gradually decreased after 5 days.However,the intervention group was lower than the control group in all observed pilots,and the differences between groups were statistically significant(P<0.05).2 After admission,NIHSS scores in the intervention group and the control group had the same trend of change,and both decreased gradually.However,the intervention group was lower than the control group in all observed pilots,and the differences between groups were statistically significant(P<0.05).3 The distribution of life dependence was different between the intervention group and the control group,the number of moderate and severe life dependence in the intervention group was lower than that in the control group,and the difference was statistically significant(P<0.05).4 The rate of good prognosis in the intervention group was higher than that in the control group,and the differences were statistically significant(P<0.05).5 The incidence of adverse events in the intervention group was lower than that in the control group,and the differences were statistically significant(all P<0.05).Under bridging arterial thrombectomy,the rate of bleeding at other sites in the intervention group was lower than that in the control group(P<0.05).However,there was no statistical difference in bleeding at other sites between the intervention group and the control group in patients undergoing conventional treatment and intravenous thrombolysis(all P>0.05).6 After 90 days of follow-up,it was found that the death rate in the intervention group was lower than that in the control group,but the difference was not statistically significant(P>0.05).7 All the related factors that may affect the prognosis of patients were analyzed,and the results showed that the influence of blood pressure regulation on the prognosis of patients with acute severe cerebral infarction was statistically significant(P<0.05).Conclusions 1 Controlling systolic blood pressure between 130-140 mm Hg in patients with acute severe cerebral infarction can reduce intracranial pressure,reduce the scope of brain tissue edema,and do not increase the incidence of cerebral hernia.2 Controlling the systolic blood pressure in the 130-140 mm Hg in the acute stage of severe cerebral infarction can promote the recovery of neurological function,improve the quality of life and improve the prognosis of patients after 3 months.3 Controlling blood pressure within the 130-140 mm Hg compared recommended by the guidelines in patients with severe cerebral infarction during the acute phase can reduce the incidence of adverse events within 14 days of hospitalization,especially bleeding,and does not increase the risk of death within 90 days.Figure 0;Table 30;Reference 120... |
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