The Application Of Different Blood Pressure Monitoring Methods After Endovascular Treatment Of Acute Ischemic Stroke

Objective: to study the correlations and differences of the non-invasive blood pressure?NIBP?of the brachial artery,the invasive blood pressure of the transducer at the level of the external auditory meatus(IBP_brain)and the level of the heart(IBP_heart)in patients with acute ischemic stroke?AIS?after endovascular treatment.Value the 24 h Blood pressure variability?BPV?and the recovery when regulate the blood pressure on the basis of IBP_brain and IBP_heart.To find the best measurement method,to guide clinical medication and nursing.Methods: A total of 78 critically ill patients were enrolled in the intensive care unit of neurology department of the First Hospital of Jilin University in this prospective observative study from 2017.10 to 2018.09.The brachial artery NIBP and radial artery IBP were performed simultaneously.Blood pressure data were recorded every 15 min within 2h after the operation,30 min within3-8h after the operation,and 60 min within 9-24 h after the operation.To comparing the differences of NIBP,IBP_heart and IBP_brain in systolic,diastolic and mean blood pressure?SBP,DBP and MAP?levels in neurocritically ill patients.40 patients enrolled from 2017.10 to 2018.03 were used as the control group,and 38 patients enrolled from 2018.04 to 2018.09 were used as theexperimental group.IBP_heart was used as the treatment basis in the control group,and IBP_brain was used as the treatment basis in the experimental group.BPV,complications,NIHSS score within 24 hours after surgery and modified Rankin Scale?m RS?at 3 months after onset were compared between the two groups.Results: Finally,2416 groups of data were collected,Each group of data contains NIBP,IBP_brain,and IBP_heart at the same time.?1?The differences of IBP_heart,IBP_brain and NIBP measurement results of the same patient were compared,and the results showed that:IBP_heart overestimated IBP_brain for SBP?11.8 ± 4.91?mm Hg,P<0.001;MAP?12.61±2.05?mm Hg,P<0.001 ?IBPheart overestimated NIBP for SBP?7.36±4.26?mm Hg,P<0.001;MAP?7.51±2.04?mm Hg,P<0.001?NIBP overestimated IBP_brain for SBP?4.65±1.82 mm Hg?P< 0.001;MAP?4.43±2.20?mm Hg,P<0.001 ??2?IBP_brain and IBP_heart were used as the basis of blood pressure regulation in the experimental group and the control group,.Comparison of the BPV,complications,NIHSS score at 24 h after surgery and m RS score at 3 months after surgery,and the results showed that:Compared with the control group,SBPSVheart,SBPSVbrain and SBPSVNIBP were all lower than the control group.?t =5.196,6.942,3.981,P<0.001?.The number of cerebral edema in the experimental group and the control group was divided into 7?18.4%?and 16?40%?,and the number of vascular reocclusion was 3?9.4%?and 10?28.6%?,with statistically significant differences?P<0.05?.The incidence of hemorrhage transformation in the two groups was 3?7.9%?and 6?15.0%?,and the difference was not statistically significant?P>0.05?.There was no significant difference between the experimental group and the control group in DBPSVheart,DBPSVbrain and DBPSVNIBP?P>0.05?.There was no significant difference in the improvement of 24 h NHISS score?baseline NHISS-24 h NHISS postoperatively?or the improvement of Rankin score 3 months later between the two groups?P>0.05?.Conclusion: The comparison of different blood pressure monitoring methods showed that the three blood pressure monitoring methods have strong correlation and difference,IBP_heart was significantly higher than IBP_brain and NIBP.Place the pressure transducer in the external auditory level is simple and easy to clinical nursing,Taking IBP_brain as the basis of postoperative blood pressure regulation in AIS patients after endovascular treatment can reduce the dosage of vasoactive drugs,reduce the fluctuation range of blood pressure in postoperative patients and allow better perfusion of ischemic brain tissue,thus reducing the risk of postoperative cerebral edema and vascular re-occlusion.For patients undergoing IBP monitoring after endovascular therapy,theplacement of the transducer should be confirmed and the blood pressure management should be standardized,which is of great importance for the treatment and nursing of AIS patients after endovascular therapy.