Objective To analyze the correlation between blood pressure(BP)level and early neurological function improvement in patients with acute ischemic stroke(AIS)after intravenous thrombolysis,and study the optimal range of BP for neurological function improvement.Methods Based on observational study design,AIS patients received intravenous thrombolysis were chosen Beijing qualified hospital for emergency stroke treatment from 2018 to 2021.The neurological status of patients 2 h after intravenous thrombolysis was assessed through scoresof National Institute of Health Stroke Scale(NIHSS),and scores of 0 to 1 were defined as early neurological improvement.The correlation curve between BP level and NIHSS scores wasfitted by using multi-factor model combined with restricted cubic spline analysis.The reference BP range was selected according to the inflection point of the correlation curve.The correlation between different BP levels and early neurological function improvement was studied by using multi-factor model.Results There were totally 15,703 AIS patients included,the average age was 64.9 years old,and male cases accounted for 69.2％.The mean systolic pressure(MSP)was 150.8 mmHg and mean diastolic pressure(MDP)was 85.4 mmHg in acute stage.The early neurological function was improved in 4,780 patients(30.4％)after intravenous thrombolysis.There was a U-shaped correlation between BP and NIHSS scores 2 h after intravenous thrombolysis.NIHSS scores were the lowest when systolic blood pressure(SBP)was 156 mmHg and diastolic blood pressure(DBP)was 96 mmHg in acute stage.The percentages of patients with SBP＜145 mmHg or SBP＞165 mmHg were lower compared with those with SBP145～165 mmHg[(OR=0.87,95％CI:0.80～0.95,P＜0.05;OR=0.90,95％CI:0.82～0.99,P＜0.05)].The percentages of patients with DBP＜90 mmHg or DBP＞100 mmHg were lower compared with those with DBP 90～100 mmHg[(OR=0.86,95％CI:0.80～0.94,P＜0.05;OR=0.91,95％CI:0.79～0.99,P＜0.05)].The above-mentioned correlations were also observed in subgroups of different sex,age and hypertension history.Conclusion There is a nonlinear correlation between BP level in acute stage and early neurological function improvement in AIS patients after intravenous thrombolysis.The optimal BP range is 145～165 mmHg and 90～100 mmHg.The higher or lower BP levels in acute stage is not conducive to early neurological function improvement.
关键词
急性期血压水平/急性缺血性脑卒中/静脉溶栓治疗
Key words
Blood pressure level in acute stage/Acute ischemic stroke/Intravenous thrombolysis
维普
万方数据