| Background:In recent years,the incidence of cerebral Ischemic stroke(CIS)has been increasing year by year.Due to the decrease of population ageing and early mortality after stroke,the need for stroke rehabilitation and the economic,social and family burden of stroke are expected to increase in the coming years.It is important to study the related factors affecting the functional prognosis of stroke patients for the rational selection of treatment,the establishment of discharge plans,and the prediction of the necessity of family and community support.Studies have shown that increased blood pressure variability is associated with an increased risk of adverse outcomes 3 months after stroke,independent of the level of blood pressure itself,but its effect on the degree of motor recovery after stroke is uncertain.Objective:Whether the fluctuation of blood pressure in a certain period of time has an effect on the prognosis of ischemic stroke patients is still under debate,and this study uses three representative indicators of blood pressure variability:standard deviation,coefficient of variation and mean true variability to explore the correlation of daily blood pressure variability of ischemic stroke patients on their motor function recovery,so as to provide a basis for stable clinical blood pressure reduction,prediction of ischemic stroke motor function recovery,and formulation of reasonable treatment plans.Methods:A retrospective analysis was performed for 156 patients admitted to the Department of Rehabilitation Medicine of Northern Jiangsu People’s Hospital due to ischemic stroke from December 2021 to December 2022.Collect general data of all enrolled patients,monitor blood pressure,and calculate blood pressure variability(BPV)related indicators,including standard deviation(SD),coefficient of variation(CV),and average real variation(ARV),According to the quartile of the above indicators of daily blood pressure variability for 7 consecutive days,the patients were divided into four groups(Q1-Q4),and the difference in Fugl-Meyer assessment(FMA)score at admission and 8 weeks after rehabilitation was used as the main index,the baseline data were analyzed,and the FMA,Berg balance scale(BBS),modified Barthel index(MBI),and Functional Comprehensive Assessment(FCA)scales were compared between the four groups to explore the correlation between blood pressure variability and various indexes in CIS patients and the factors affecting the degree of motor function recovery in CIS patients.The analysis was used to compare the factors for statistical differences between groups.The measured data were statistically measured by SPSS software,and there was a significant difference in P<0.05.Results:1.Comparison of the differences in FMA,BBS,MBI and FCA scores in four groups:The differences in FMA,BBS,MBI and FCA scores were compared between the groups with the differences in FMA,BBS,MBI scores and FCA scores in four groups,and the difference between FMA,BBS and FCA scores was P<0.05,indicating that there were statistical differences between FMA,BBS and FCA scores between the groups.2.Single variate analysis of FMA score difference:FMA score difference was positively correlated with BBS,MBI score and FCA score difference,and the correlation coefficients were 0.484,0.326 and 0.334(P<0.05),respectively.The difference in FMA score was negatively correlated with age,smoking history,and drinking history,with correlation coefficients of-0.267,-0.541,and-0.317(P<0.05),respectively.3.Univariate analysis of BBS score difference:BBS score difference was positively correlated with FMA,MBI score and FCA score difference,and the correlation coefficients were 0.484,0.304 and 0.490(P<0.05),respectively.The difference in BBS score was negatively correlated with age,smoking history and drinking history,and the correlation coefficients were-0.207,-0.286 and-0.200(P<0.05),respectively.4.Single-factor correlation analysis of MBI score difference:MBI score difference was positively correlated with FMA,BBS and FCA score difference,and the correlation coefficients were 0.326,0.304 and 0.579(P<0.05),respectively.The difference in MBI score was negatively correlated with smoking history,and the correlation coefficient was0.214(P<0.05).5.Single-factor correlation analysis of FCA score difference:The difference in FCA scale scores was positively correlated with FMA,BBS and MBI,with correlation coefficients of 0.334,0.490 and 0.579(P<0.05),respectively.The difference in FCA scale scores was negatively correlated with gender,smoking history,drinking history,and TC,and the correlation coefficients were-0.269,-0.225,-0.161,-0.172(P<0.05).The difference in FCA scale score was positively correlated with HDL-C,and the correlation coefficient was 0.309(P<0.05).6.FMA score difference multivariate linear regression:the P-values of sex,HDL-C and TC regression tests were 0.958,0.577 and 0.771(P≥0.05),respectively,indicating that their influence on the dependent variable was not statistically significant when other variables remained unchanged,and the P-values of smoking and age regression tests were not statistically significant<0.05,indicating that the effect on the dependent variable was statistically significant when other variables remained unchanged,and the partial regression coefficients were all less than 0,so smoking history and increasing age would lead to a decrease in the dependent variable.For SD grouping,group Ⅳ was used as the reference layer:for group Ⅰ.-group Ⅲ.,the P-values of regression tests were 0.073,0.308,respectively.0.715(P≥0.05),indicating that the influence of SD on the dependent variable was not statistically significant;for the CV grouping,group Ⅳwas used as the reference layer:for group Ⅰ.,the regression test P<0.05 indicated that the effect on the dependent variable was statistically significant when other variables remained unchanged,and the partial regression coefficient was greater than 1,so the C V grouping level decreased,and the dependent variable increased;for group Ⅱ.and group Ⅲ.,the P-values of the regression test were 0.099 and 0.445(P≥0.05),respectively,indicating that group Ⅱ.and group Ⅲ were 0.099 and 0.445(P≥0.05),indicating that group Ⅱ.and Group Ⅱ The effect of CV on the dependent variable was not statistically significant in Group Ⅲ.For ARV grouping,group Ⅳ was used as the reference layer:for group Ⅰ.-group Ⅲ.,the P-values of regression tests were 0.998,0.080 and 0.319(P≥0.05),respectively,indicating that the effect of ARV on the dependent variable was not statistically significant.7.BBS score difference multivariate linear regression analysis:age,gender,drinking,HDL-C and TC regression test P-values were 0.232,0.908,0.985,0.285,0.229(P≥0.05),respectively,indicating that the effect on the dependent variable was not statistically significant when other variables remained unchanged;smoking regression test P-value<0.05,indicating that the effect on the dependent variable was statistically significant while the other variables remained constant,and the partial regression coefficients were all less than 0,so having a history of smoking would lead to a decrease in the dependent variable.For the SD grouping,group Ⅳ was used as the reference layer:for group Ⅰ.-group Ⅲ.,the P-values of the regression test were 0.223,0.863 and 0.968(P≥0.05),respectively,indicating that the effect of SD on the dependent variable was not statistically significant;for the CV group,group Ⅳwas used as the reference layer:for group Ⅰ.-group Ⅲ.,the P-values of the regression test were 0.133,0.924,respectively.0.845(P≥0.05),indicating that the influence of CV on the dependent variable was not statistically significant;for the ARV grouping,group Ⅳ was used as the reference layer:for group Ⅰ.,the regression test P<0.05 indicated that the effect on the dependent variable was statistically significant when other variables remained unchanged,and the partial regression coefficient was greater than 1,so the ARV grouping level decreased,and the dependent variable increased;for group Ⅱ.and group Ⅲ.,the P-values of the regression test were 0.485 and 0.909(P=0.05),respectively,indicating that group Ⅱ.and group Ⅲ were 0.485 and 0.909(P≥0.05),indicating that group Ⅱ.and group Ⅲ were The effect of ARV on the dependent variable in group Ⅲ was not statistically significant.8.MBI score difference multivariate linear regression analysis:age,gender,smoking,drinking,HDL-C and TC regression test P-values were 0.440,0.457,0.104,0.629,0.270,0.241(P≥0.05),respectively,indicating that their influence on the dependent variable was not statistically significant when other variables remained unchanged.For the SD grouping,groupⅣ was used as the reference layer:for group Ⅰ.-group Ⅲ.,the P-values of regression tests were 0.334,0.209 and 0.867(P≥0.05),respectively,indicating that the effect of SD on the dependent variable was not statistically significant;for the CV group,group Ⅳ was used as the reference layer:for group Ⅰ.-group Ⅲ.,the P-values of regression tests were 0.161,0.279,and 0.953(P≥0.05),respectively,indicating that the effect of CV on the dependent variable was not statistically significant,and the effect of ARV on the dependent variable was not statistically significant,with group Ⅳ as the reference layer:for group Ⅰ.-group Ⅲ.,the Pvalues of regression tests were 0.710,0.884 and 0.419(P≥0.05),indicating that the effect of ARV on the dependent variable was not statistically significant.9.Multivariate linear regression analysis of FCA scale score difference:the P-values of gender,drinking and TC regression tests were 0.820,0.825 and 0.052(P≥0.05),respectively,indicating that the effect on the dependent variable was not statistically significant when other variables remained unchanged;smoking,age,and HDL-C regression test P-values<0.05,indicating that the effect on the dependent variable was statistically significant when other variables remained unchanged,and the partial regression coefficients of smoking and age were less than 0,so smoking history and increasing age would lead to a decrease in the dependent variable,and the HDL-C partial regression coefficient was greater than 1,so HDL-C increased,and the dependent variable increased.For the SD grouping,group Ⅳ was used as the reference layer:for group Ⅰ.-group Ⅲ.,the P-values of the regression test were 0.059,0.987 and 0.716(P≥0.05),respectively,indicating that the effect of SD on the dependent variable was not statistically significant;for the CV group,group Ⅳ was used as the reference layer:for groupⅠ.-group Ⅲ.,the P-values of the regression test were 0.054,0.917,respectively.0.477(P≥0.05),indicating that the influence of CV on the dependent variable was not statistically significant;for the ARV grouping,group Ⅳ was used as the reference layer:for group Ⅰ.,the regression test P<0.05 indicated that the effect on the dependent variable was statistically significant when other variables remained unchanged,and the partial regression coefficient was greater than 1,so the CV grouping level decreased,and the dependent variable increased;for groupⅡ.and group Ⅲ.,the P-values of the regression test were 0.277 and 0.284(P≥0.05),respectively,indicating that group Ⅱ.and group Ⅲ were 0.277 and 0.284(P≥0.05),indicating that group Ⅱ.and group Ⅲ.The effect of CV on the dependent variable was not statistically significant in Group Ⅲ.Conclusions:1.SBP-CV was correlated with the difference of Fugl-Meyer Assessment score,SBPARV was correlated with the difference of Berg balance scale and functional comprehensive assessment scale,and SBP-CV was correlated with the difference of Fugl-Meyer Assessment score,there was no significant correlation between SBP-SD and Fugl-meyer Assessment score difference,Berg balance scale,modified Barthel index and functional comprehensive assessment scale.2.Age,smoking and drinking were the unfavorable factors for the recovery of motor function in patients with CIS.HDL-C had positive significance for the recovery of motor function in patients with CIS.3.SBP-CV and SBP-ARV were significantly correlated with the recovery of motor function in patients with CIS at the recovery stage,and were unfavorable factors for the prognosis of CIS.Compared with SBP-SD,SBP-CV and SBP-ARV were better predictors of the recovery of motor function in patients with CIS,it is suggested that paying attention to the stability of blood pressure in clinic may have more positive significance to the rehabilitation effect. |
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