| Background and objective:Stroke with high rate of incidence,morbidity,mortality and recurrence,is the first cause death in Chinese population,which renders serious trouble on the national health and the quality of people's life.Intravenous thrombolysis therapy is currently one of the best medical treatment approaches for patients with acute cerebral infarction.It significantly alleviates symptoms,reduce morbidity and mortality rate thus improves prognosis.Studies have shown that changes in blood pressure in patients with cerebral infarction after thrombolysis are significantly correlated with prognosis,and particularly the decrease of blood pressure in a short time after that procedure which may be the manifestation of revascularization or reperfusion of brain tissue is related to good prognosis.Our study is to find the relationship between blood pressure changes during the process of rt-PA infusion and 3-month prognosis evaluated by modified Rankin Scale,and further looking for the related influencing factors to better understand this disease and help daily clinical practice.Methods: We collect patients' data form May 2015 to Oct 2017 who have received intravenous thrombolysis in the stroke center of the first hospital of Jjilin university,including demography,medical history,personal history,lab test results,imaging,and other related information and analyze it in a retrospective manner.Blood pressure is taken in a regular interval of 15 min before and during the infusion process of rt-PA.Firstly,patients are devided into two groups according the different 3-month prognosis atatus: patients with m RS?2 are labelled as “favorable outcome group”,and others with mRS?3 are labelled as “unfavorable outcome group” Univariate analysis is conducted to differentiate factors that might cause the distinguished prognosis status and multivariate analysis is followed to certify.Secondly,in order to find out whether blood pressure decrease influences outcome after stroke,patients are devided into two groups according to the different features of blood pressure during rt-PA infusion process.Chi-squared test is run to exam the prognosis difference.And univariate analysis of blood pressure is processed to test factors that may contribute to blood pressure decrease.And also multivariate analysis is followedResults: From 2015-05 to 2017-10,500 patients treated with intravenous thrombolysis were consecutively enrolled in this research.488 patients were followed-up 3-month after thrombolysis among whom 458 patients' clinical date are complete.3 months follow-up results showed that the 312 cases have favorable outcome(mRS?2),while 176 cases are in unfavorable outcome group.Univariate analysis showed that the baseline NIHSS score is significantly lower in patients with good prognosis(8.25 + 5.57 vs.13.51 + 7.42,p=0.000)and CT ASPECTS were higher(8.65 + + 1.82 and 8.13 + 2.00,p=0.005);The prevalence of hypertension is higher(40% VS 54%,p=0.011)in unfavorable outcome group.In the process of thrombolysis,patients with a blood pressure drop have better chance to get favorable prognosis(69.4% VS 59.8%,p=0.037)and hemorrhage transformation(regardless of type)rate is lower(16% VS 23.9%,p=0.034).It was noted that baseline blood pressure,history of hypertension,baseline ASPECT score,and hemorrhage transformation are all independent factors associated with changes in blood pressure.Patients are more likely to have a decrease in blood pressures whose baseline blood pressure are higher(OR 1.02,95% ci 1.01 1.031,p = 0.000),While hypertension is a negative factor(OR 0.602,95% ci 0.38 0.952,p = 0.030).Baseline CT ASPECT score also influences blood pressure independently(OR 1.139,95% C.I.,1.024-1.267,p=0.017).Lower blood pressure is the preventive factor for hemorrhage transformation of after thrombolysis(OR 0.517,95% CI.0.31-0.864,p=0.012).In the end,the multivariate analysis of the prognosis of cerebral infarction found that the only CT ASPECT score(OR 1.295,OR95% CI 1.154-1.454 p < 0.05)and the baseline NIHSS score(OR 0.894 95% CI 0.860-0,930,p < 0.05)are independent prognostic factors.The other factors,such as gender,age,cerebral infarction /TIA history,diabetes mellitus and other common risk factors,haven't show significant effect on the prognosis of patients.Conclusions: Spontaneous blood pressure decrease in patients with acute cerebral infarction treated with IVT(intravenous thrombolysis)during rt-PA infusion is positively corelated with favorable prognosis,but it is not an independent prognostic factor.Instead,baseline ASPECT score and NIHSS score are independent prognostic factors for rt-PA treated patients. |
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