| Objective:To analyze the influence between the differences of blood pressure in ischemic stroke in acute phase, hemodynamics and neurologic deficits.Methods:Consecutive patients diagnosed as ischemic stroke within 72h of onset were registered prospectively and strictly selected according to the inclusion criteria and exclusion criteria. Patients’blood pressure was monitored and rated by NIHSS scale. And the effects of blood pressure changes on cerebrovascular hemodynamics and neurologic deficits were discussed through cerebral blood flow in the main blood vessels measured by TCD measurement, cerebrovascular reactivity by breath holding test, and local brain blood flow measured by magnetic resonance perfusion imaging. Statistical methods:all the data were analyzed by SPSS 16.0. Chi-square test was used for enumeration data. Measurement data was presented as mean ± standard deviation (x±s). t test was used for measurement data while χ2 test was for enumeration data; Logistic multiple factors regression analysis was used for correlation and difference examination; P<0.05 referred to statistically significant differences.Results:1. Comparison of cerebral vascular reactivity in patients with acute ischemic stroke and different degrees of hypertension:the groups were compared with single factor analysis of variance, and the results showed a statistically significant difference (F=3.529, P<0.06). Pairwise comparison of results showed:there was no significant difference between hypertension grade 3 group and hypertension grade 2 group in BHI (t=-2.014, P=0.0541), but significantly lower than the other 2 groups (t= 3.942,-3.687, P=0.0004,0.0024). And there were no significant differences between hypertension grade 1 group and non-hypertension group in BHI (t=0.343, P=0.7339).2. Comparison of cerebral vascular reactivity in patients with acute ischemic stroke with different diseased years:BHIs of patients with hypertension for 16-20 years and for 11-15 years were significantly lower than that of patients with hypertension<5 years, the differences were of statistical significance (t=2.680,2.673, P=0.0368,0.0372); there was no statistically significant differences between patients with hypertension<5 years and patients with hypertension for 6-10 years in BHI (t=0.159, P=0.8745).3. Comparison of cerebrovascular reactivity in patients with different types ofacute ischemic stroke:there was no significant difference between CE and PAD patients in BHI (t=0.100, P=0.9214); BHI values of LAA patients were significantly decreased than those in group CE and group PAD (t=2.876,3.980, P=0.0069,0.0041) with statistically significant difference.4. Comparison of cerebral vascular reactivity in patients with acute ischemic stroke and different neural function defects:according to NIHSS scale score, patients with severe neurological impairment namely NIHSS>20 had different BHI compared to the other two groups (t=-2.836,-3.644, P=0.0074,0.0010).5. Comparison of cerebral hemodynamics in patients with acute ischemic stroke in different time segment:an independent samples t test analysis was used for 2 groups of patients, and the results showed:BHI and cerebral microcirculatory blood flow in patients of 7-day group were obviously increased compared to 3-day group (t=-4.968, 3.990, P=0.0000), and the difference was statistically significant.Conclusion:1. The degree of high blood pressure could influence the cerebrovascular reactivity of patients with ischemic stroke in actuate phase. The more serious the degree of high blood pressure is, the worse the cerebrovascular reactivity is.2. The duration of high blood pressure could also influence the cerebrovascular reactivity of patients with ischemic stroke in actuate phase. The longer the previous duration of high blood pressure lasts, the poorer the blood controls, the worse the cerebrovascular reactivity is.3. Classified with newest Chinese ischemic stroke subtypes (CISS), the CVR of LAA patient is the worst. However, there are no obvious differences between CE and PAD patients with high blood pressure in CVR.4. For patients with acute ischemic stroke and mild and moderate neurologic impairment, there is no obvious difference in the descend range of CVR. While for the patients with severe neurologic impairment, there is obvious decrease in CVR.5. The CVR of acute ischemic stroke patients is different in various times. With the condition improves, CVR would be recovered to some extent. The ischemic stroke in acute stage accompanied with high blood pressure is automatically decreased, while the blood flow around the local brain tissue in affected side is not obviously decreased with the fall of blood pressure. |
PDF Full Text Request