Correlation Between Blood Pressure Variability And Prognosis Of Patients After Thrombolysis In Acute Ischemic Stroke

To explore the correlation between blood pressure variability and the prognosis of patients with acute ischemic stroke after thrombolysis,and to provide the basis for medical staff to monitor and manage blood pressure changes,so as to better improve the prognosis of patients.Methods A retrospective study was conducted.From January 2021 to December 2022,patients with acute ischemic stroke who received intravenous thrombolytic therapy in the Department of Neurology of the Affiliated Central Hospital of Shenyang Medical College were selected as the research objects.Demographic and clinical data of the patients were collected and recorded.Blood pressure values were recorded within 24 hours after thrombolytic therapy.Blood pressure variability was assessed by maximum value(max),minimum value(min),mean value(mean),standard deviation(SD),coefficient of variation(CV),and continuous variability(SV).10 d m RS>2 was considered as poor short-term prognosis.90 d m RS>2 was considered as poor longterm prognosis.Intracranial hemorrhage was considered if cranial hemorrhage was found on review of head CT after thrombolysis.After correction of demographic and clinical data,multifactorial logistic regression analysis was performed to verify the correlation between blood pressure variability parameters and short-term prognosis,long-term prognosis and intracranial hemorrhage.Results1.A total of 156 patients were enrolled.Among them,26 cases were excluded for less than 10 days,10 cases had incomplete 24-hour blood pressure records,10 cases were treated with endovascular retreatment during hospitalization,6 cases were lost to follow-up,and finally 104 cases were included.Short-term prognosis: 68 cases in the good group and 36 cases in the poor group.Long-term prognosis: 65 cases in the good group and 39 cases in the poor group.There were 8 cases of intracranial hemorrhage and 96 cases of no intracranial hemorrhage.2.Short-term prognostic univariate analysis showed: DNT time,Urapidil,WBC count,APTT,baseline NIHSS score,SBP max,SBP min,SBP mean,SBP SD,SBP CV,SBP SV,DBP max,DBP min,DBP SD,DBP CV,DBP SV was related to the prognosis of 10 days.3.Univariate analysis of long-term prognosis showed that DNT time,height,Urapidil,WBC count,APTT,baseline DBP,baseline NIHSS score,SBP max,SBP min,SBP SD,SBP CV,SBP SV,DBP min,DBP SD,DBP CV,DBP SV were associated with 90-day prognosis.4.Single factor analysis of intracranial hemorrhage showed that red blood cell count,hemoglobin,SBP max,SBP min,SBP SD,SBP CV,SBP SV,DBP min,DBP SD,DBP CV and DBP SV were related to intracranial hemorrhage.5.Multivariate analysis showed that SBP SV(OR: 1.473,95% CI(1.128,1.923),P= 0.004),DBP SV(OR: 1.717,95% CI(1.097,2.788),P = 0.018)was the influencing factor of poor short-term prognosis in patients with acute ischemic stroke after thrombolytic therapy.6.Multivariate analysis of long-term prognosis showed that SBP SV(OR:1.505,95% CI(1.147,1.974),P = 0.003),DBP SV(OR: 1.635,95% CI(1.056,2.531),P = 0.003)and DBP SV were significantly higher than those of the other groups.P =0.027)was the influencing factor of poor long-term prognosis in patients with acute ischemic stroke after thrombolytic therapy.7.Multivariate analysis showed that SBP SV(OR: 2.197,95% CI(1.293,3.733),P= 0.004)was the influencing factor of intracranial hemorrhage in patients with acute ischemic stroke after thrombolytic therapy.Conclusion1.DNT time and baseline NHISS score were related to the short-term and longterm prognosis of patients with acute ischemic stroke treated with thrombolysis.The longer the DNT time and the higher the baseline NHISS score,the worse the prognosis.2.24 hours after thrombolysis,SBP SV and DBP SV were positively correlated with short-term and long-term poor prognosis in patients with acute ischemic stroke.The larger the SBP SV and DBP SV,the worse the prognosis.3.There was a positive correlation between SBP SV at 24 hours after thrombolysis and intracranial hemorrhage in patients with acute ischemic stroke.The greater the SBP SV at 24 hours after thrombolysis,the higher the risk of intracranial hemorrhage.4.Initial blood pressure values do not predict any outcome.