Relationship Between Mean Arterial Pressure Before Intravenous Thrombolytic Therapy And The Prognosis Of Patients With Acute Ischemic Stroke

Objective Ischemic stroke,a nervous system disease with rapid onset and shorted to the peak,has the neurological impairment or consciousness disturbance more than 24 hours caused by hypoperfusion of brain tissue.Intravenous thrombolytic therapy can improve the symptoms of patients with acute stroke to decrease disability rate,mortality rate of stroke and to improve the prognosis of patients.Mean arterial pressure is closely associated with cerebral perfusion level and short-term prognosis of stroke patients.At present,the relationship between mean arterial pressure before thrombolysis and prognosis in patients with acute ischemic stroke is not clear.This paper aims to explore the relationship between mean arterial pressure before Intravenous thrombolytic therapy and the prognosis of patients with acute ischemic stroke,by measuring the baseline blood pressure before thrombolytic therapy.Methods Prospective continuous intravenous thrombolytic therapy was performed at the first affiliated Hospital of Zhengzhou University from January 2016 to December 2017 for patients with acute ischemic stroke who met the exclusion criteria.After admission,emergency neurologists used non-paralytic non-invasive monitoring devices to measure temporary supine blood pressure.The systolic and diastolic pressure of the patients was recorded and the mean arterial pressure was calculated.Mean arterial pressure =(systolic pressure + 2diastolic pressure)/3 and Pulse pressure(pulse pressure = systolic pressure-diastolic pressure).According to the mean arterial pressure and pulse pressure quartile spacing,the patients were divided into 4 groups.Patients were divided into good prognosis group(m RS score ≤ 1)and poor prognosis group(m RS score ≥ 2)according to the early prognosis m RS score of(90±3)days after onset.The data were statistically analyzed by using SPSS 21.0 software.The prognostic factors of acute ischemic stroke patients with venous thrombolysis were analyzed by univariate and multivariate logistic regression analysis.Results The study included 258 patients with acute ischemic stroke who accord with the exclusion criteria,85 women and 173 men,aged59.49±13.1years.The mean time from onset to venous thrombolysis was 184.55 ±83.936 minutes.The NIHSS score was 5.39 ±3.433.There were 198 patients with good prognosis and 60 patients with poor prognosis.Univariate logistic regression analysis showed that the score of nihss was the main risk factor for the prognosis of patients with acute ischemic stroke on day(90±3)(p < 0.01).Diastolic blood pressure(DBP)before thrombolytic therapy was correlated with the prognosis of(90±3)days after thrombolytic therapy.The results of multivariate logistic regression analysis showed that there was a significant correlation between diastolic blood pressure and prognosis of(90±3)days after thrombolysis.With pulse pressure ≥ 79 mmhg as reference,the prognosis of patients with pulse pressure < 59 mmhg was different at(90±3)days after onset(P =0.036).The mean arterial pressure of 97 ~ mmhg group and 106 ~ mmhg group had a better prognosis at(90±3)days after stroke onset(p = 0.038,0.041),which suggested that they were protective factors for the prognosis of patients with acute ischemic thrombolytic stroke.Conclusion The mean arterial pressure before thrombolysis can be used as a predictor of prognosis in patients with acute ischemic stroke.