Study On The Relationship Between Blood Pressure Management And Adverse Events Within 24 Hours After Intravenous Thrombolysis In Patients With Cerebral Infarction And Hypertension

Objective: This experiment aims to study the effects of blood pressure control goals,blood pressure variability,and blood pressure lowering speed on the occurrence of adverse events within 24 hours after intravenous thrombolysis in patients with cerebral infarction and hypertension.For reduce the occurrence of adverse events,increase the individuality of the post-thrombolysis blood pressure control programs and improve prognosis,there is a great significance.Methods: A total of 71 patients with acute cerebral infarction and hypertension treated by intravenous thrombolysis(August 2017-November 2020)who were admitted to the Department of Neurology in our hospital were selected.Their general data were collected,including gender,age,the history of hypertension,Diabetes,hyperlipidemia,stroke,coronary heart disease,smoking and drinking,BMI,NIHSS within 24 hours after admission and thrombolysis,head imaging examination results,etc.Groups are grouped according to blood pressure control target,blood pressure variability,blood pressure lowering speed,and responsible blood vessel of infarct site.I record the highest value of systolic blood pressure within 24 hours after thrombolysis as a blood pressure control target,and calculate blood pressure variability and blood pressure reduction rate within 24 hours after thrombolysis.And then I record the PI data of the middle cerebral artery on the affected side by TCD,and calculate the highest and lowest NICP and the corresponding CPP.Afterwards I count the number of adverse events(including the occurrence of cerebral hypoperfusion,cerebral hyperperfusion,progressive cerebral infarction and hemorrhage after cerebral infarction).Finally I analyze whether the blood pressure control goal,blood pressure variability,and blood pressure lowering speed are related to the occurrence of adverse events,calculate the intensity of the three factors related to the occurrence of adverse events,understand whether the above analysis results are different between the anterior circulation group and the posterior circulation group,and find the ideal blood pressure control goals,blood pressure variability,and blood pressure lowering speed.Results:1.Hyperlipidemia(P=0.000<0.05),BMI(P=0.001<0.05)and hospitalized NIHSS(P=0.028<0.05)have statistically significant correlation with blood pressure variability.The difference between the anterior circulation group and the posterior circulation group in the diabetes history was statistically significant(P=0.005<0.05),and the diabetes history incidence of the posterior circulation group(46.15%)was significantly higher than that of the anterior circulation group(15.56%).2.The difference in the occurrence of adverse events between the blood pressure control target groups was statistically significant(P=0.040<0.05).There was a statistically significant difference in hypoperfusion(P=0.000<0.05)and high perfusion(P=0.000<0.05)between the groups.When the blood pressure control target was 161-180 mm Hg,the incidence of adverse events was the lowest(72.22%).3.There was a statistically significant difference in the occurrence of adverse events between the groups grouped by blood pressure variability(P=0.009<0.05).And there was a statistically significant difference in hyperperfusion between groups(P=0.000<0.05).4.There was a statistically significant difference in the occurrence of adverse events between the groups grouped by the rate of blood pressure reduction(P=0.030<0.05).There was a statistically significant difference in the occurrence of progressive cerebral infarction(P=0.041<0.05)between the groups,too.5.In the anterior circulation group,there was no statistically significant difference in blood pressure reduction speed,blood pressure variability,and adverse events between the control target groups.But there were statistically significant differences in hypoperfusion(P=0.001<0.05)and high perfusion(P=0.000<0.05)between groups grouped by blood pressure control goals.And there was a statistically significant difference in hyperperfusion(P=0.043<0.05)between groups grouped by blood pressure variability.6.In the post-circulation group,there was a statistically significant difference in the occurrence of adverse events between the groups grouped by the rate of blood pressure reduction(P=0.048<0.05),but there was no statistically significant difference in the occurrence of adverse events between the groups grouped by blood pressure control goals and blood pressure variability(P>0.05).There were statistically significant differences in hypoperfusion(P=0.034<0.05)and high perfusion(P=0.000<0.05)between groups grouped by blood pressure control goals.There was a statistically significant difference in hyperperfusion(P=0.007<0.05)between groups grouped by blood pressure variability.7.The incidence of adverse events is statistically significant in relation to the rate of blood pressure reduction(P=0.046<0.05)and blood pressure variability(P=0.029<0.05),but there is no statistical significance in the correlation with the control target(P>0.05).The occurrence of adverse events was positively correlated with blood pressure variability(r=0.259)and blood pressure reduction speed(r=0.238),and the correlation with variability was greater than the blood pressure reduction speed.8.The incidence of adverse events in the anterior circulation group was still not statistically significant(P>0.05).9.The incidence of adverse events in the posterior circulation group was significantly correlated with blood pressure reduction speed(P=0.019<0.05)and blood pressure variability(P=0.025<0.05),but was not correlated with blood pressure control goals(P>0.05).The occurrence of adverse events was positively correlated with blood pressure variability(r=0.438)and blood pressure reduction speed(r=0.456),and the correlation between the incidence of adverse events and the blood pressure variability was less than the blood pressure reduction speed.Conclusion:1.The occurrence of adverse events may be related to blood pressure control goals,blood pressure variability,and blood pressure lowering speed;the occurrence of adverse events is positively correlated with blood pressure variability and blood pressure lowering speed;the intensity of the three factors related to the occurrence of adverse events: blood pressure variability >blood pressure drop rate> blood pressure control target.2.Improper setting of blood pressure control targets may increase the risk of cerebral hypoperfusion and high cerebral infarction,and affect both anterior and posterior circulation cerebral infarction;excessive blood pressure variability may increase the risk of cerebral hyperperfusion in both anterior and posterior circulation cerebral infarction;the blood pressure lowering speed too fast may increase the risk of progressive stroke,and the blood pressure lowering speed may affect the occurrence of adverse events of posterior circulatory cerebral infarction more significantly.3.For patients with cerebral infarction and hypertension within 24 hours after thrombolysis,the rate of blood pressure reduction should be controlled at≤20%,blood pressure variability should be controlled at ≤20mm Hg,and blood pressure controlled at 161-180 mm Hg.4.Controlling blood lipids and reducing obesity are conducive to the control of blood pressure variability.5.Diabetes may be more likely to cause cerebral infarction in the posterior circulation.6.The admission NIHSS score may be related to blood pressure variability.