| 摘要: |
| 目的 探讨急性缺血性脑卒中静脉溶栓治疗后血压集束化管理方案对患者预后的影响。方法 收集2015年10月1日至2018年3月31日于我院脑血管病中心接受单纯静脉溶栓治疗的急性缺血性脑卒中患者286例，将其中静脉溶栓治疗后接受血压集束化管理的患者归为集束化组，未接受血压集束化管理者归为对照组。比较两组患者基线资料、入院时美国国立卫生研究院卒中量表（NIHSS）评分、溶栓前血压、溶栓后症状性颅内出血发生率和在院死亡率，以及溶栓后90 d改良Rankin量表（mRS）评分。采用多因素logistic回归分析研究血压集束化管理、NIHSS评分、发病至静脉溶栓时间、血压等对患者预后的影响。结果 286例患者中集束化组161例、对照组125例，两组年龄、性别、高血压病、糖尿病、心房颤动、入院时NIHSS评分和溶栓前血压差异均无统计学意义（P均>0.05）。集束化组患者静脉溶栓治疗后症状性颅内出血发生率低于对照组，差异有统计学意义[2.48%（4/161） vs 8.00%（10/125），χ2=4.598，P=0.032]；在院死亡率与对照组比较差异无统计学意义[3.73%（6/161）vs 3.20%（4/125），χ2=0.058，P=0.810]；90 d预后良好率（mRS评分为0～2分）高于对照组，差异有统计学意义[62.11%（100/161）vs 49.60%（62/125），χ2=4.485，P=0.034]。集束化组患者收缩压连续变异和舒张压连续变异均小于对照组[（13.37±4.92）mmHg（1 mmHg=0.133 kPa）vs（18.42±3.87）mmHg，t=2.437，P=0.025；（11.23±4.02）mmHg vs（15.48±5.16）mmHg，t=1.842，P=0.046]。多因素logistic回归分析结果显示，接受集束化管理[比值比（OR）=0.798，P=0.002]、舒张压连续变异≤15 mmHg（OR=0.816，P=0.018）为急性缺血性脑卒中静脉溶栓治疗患者预后良好的独立预测因素。结论 应用血压集束化管理有助于改善静脉溶栓急性缺血性脑卒中患者的血压变异，降低症状性颅内出血的发生率，并改善预后。 |
| 关键词: 急性缺血性脑卒中 静脉溶栓疗法 集束化管理 血压连续变异 |
| DOI：10.16781/j.0258-879x.2018.09.1034 |
| 投稿时间：2018-07-27修订日期：2018-08-16 |
| 基金项目:上海市科技创新行动计划重点项目（14401970304）. |
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| Effect of blood pressure bundle management on prognosis of patients with acute ischemic stroke after intravenous thrombolysis |
| YU Long-juan,ZHANG Ming-fei,WANG Qin,SU Dong-ying,ZHU Xuan* |
(Stroke Center, Changhai Hospital, Navy Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective The explore the effect of blood pressure bundle management on prognosis of patients with acute ischemic stroke after intravenous thrombolysis. Methods A total of 286 acute ischemic stroke patients, who received intravenous thrombolytic therapy in Stroke Center of our hospital between Oct. 1, 2015 and Mar. 31, 2018, were included in this study. The patients who received blood pressure bundle management after intravenous thrombolysis were assigned to bundle group, and the patients without blood pressure bundle management were in control group. The baseline data, National Institutes of Health stroke scale (NIHSS) score on admission, blood pressure before thrombolysis, the incidence of symptomatic intracranial hemorrhage and the in-hospital mortality after thrombolysis, and the 90-d modified Rankin scale (mRS) score were compared between the two groups. Multivariate logistic regression analysis was used to explore the effect of blood pressure bundle management, NIHSS score, onset-to-needle time, and blood pressure on prognosis of patients. Results Of 286 patients with acute ischemic stroke, 161 patients were in bundle group, and 125 patients were in control group. There were no significant differences in age, gender, hypertension, diabetes mellitus, atrial fibrillation, NIHSS score on admission or blood pressure before thrombolysis between the two groups (all P>0.05). The incidence of symptomatic intracranial hemorrhage was significantly lower in the bundle group than that in the control group (2.48%[4/161] vs 8.00%[10/125], χ2=4.598, P=0.032). There was no significant difference in the in-hospital mortality between the two groups (3.73%[6/161] vs 3.20%[4/125], χ2=0.058, P=0.810). The 90-d good prognosis (mRS score 0-2) rate was significantly higher in the bundle group than that in the control group (62.11%[100/161] vs 49.60%[62/125], χ2=4.485, P=0.034). Successive variation of systolic blood pressure and successive variation of diastolic blood pressure were significantly lower in the bundle group than those in the control group ([13.37±4.92] mmHg[1 mmHg=0.133 kPa] vs[18.42±3.87] mmHg, t=2.437, P=0.025;[11.23±4.02] mmHg vs[15.48±5.16] mmHg, t=1.842, P=0.046). Multivariate logistic regression analysis showed that blood pressure bundle management (odds ratio[OR]=0.798, P=0.002) and successive variation of diastolic blood pressure ≤ 15 mmHg (OR=0.816, P=0.018) were independent predictors for good prognosis of acute ischemic stroke patients with intravenous thrombolysis. Conclusion Blood pressure bundle management can improve blood pressure variation of the patients with acute ischemic stroke after receiving intravenous thrombolysis, reduce the incidence of symptomatic intracranial hemorrhage and improve the prognosis of the patients. |
| Key words: acute ischemic stroke intravenous thrombolytic therapy bundle management blood pressure successive variation |
