The Study On The Relationship Between Neurologic Impairment Of Acute Cerebral Infarction And Circadian Rhythm Of Blood Pressure

Background:Cerebral infarction is an acute disease of cerebrovascular disease,which seriously threatens the life and health of middle-aged and elderly people,and brings huge economic burden to families,society and the country.So far,cerebral infarction has become a global public health problem.Blood pressure plays an important role in the occurrence and development of cerebral infarction.It plays an important role in predicting the recovery of nervous function in acute stage of cerebral infarction.Therefore,accurate monitoring and optimal management of early blood pressure in patients with cerebral infarction is particularly important.In recent years,with the wide application of ambulatory blood pressure monitoring in clinical practice,people gradually realize that besides the average blood pressure,the circadian rhythm of blood pressure is also closely related to cerebrovascular events.Studies have also confirmed that abnormal circadian rhythm of blood pressure increases the incidence of cerebral infarction.However,for patients with acute cerebral infarction,the relationship between circadian rhythm of blood pressure and the time of neurological deficit aggravation remains unclear,which has been a hot topic for scholars at home and abroad.Objective:This study was conducted to analyze the relationship between the circadian rhythm of blood pressure and the increase of neurological deficit in patients with acute cerebral infarction.The purpose of this study was to investigate the circadian rhythm of blood pressure in patients with acute cerebral infarction with aggravated neurological deficit and the main period of aggravation of neurological deficit,and to further explore whether the circadian rhythm of blood pressure in patients with aggravated neurological deficit in acute cerebral infarction coincides with the main period of aggravation of neurological deficit.Methods:From March 2017 to May 2018,110 patients with acute cerebral infarction who met the inclusion criteria were enrolled in the Department of Neurology,Xianyang Hospital of Yan'an University.All basic data were collected,including age,gender,body mass index,smoking history,drinking history,and admission.Systolic blood pressure,admission diastolic blood pressure,fasting blood glucose,total cholesterol,triglyceride,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,blood uric acid,blood homocysteine,NIHSS score etc.On the second day of admission,24 h ambulatory blood pressure monitoring was performed using Wuxi Biox CB-2302-A Recording Box(Dynamic Blood Pressure Recorder).The recording time was from 08:00?09:00 in the morning to 08:00?09:00 in the next day.Using instructions:Choose the appropriate cuff to lightly bind the patient's non-temporal upper arm.The lower edge of the cuff is 2cm away from the elbow.The elastic can accommodate 2 horizontal fingers.The upper limbs of the measuring cuff are naturally drooped or laid flat on the bed.Setting parameters:The blood pressure monitoring frequency is set to at daytime(06:00?22:00)once/30min;at night(22:00?06:00)once/60 min.The effective measurement range is systolic blood pressure 70?260mm Hg,diastolic blood pressure 40?150mm Hg and pulse pressure difference 20?50mm Hg.The effective number of blood pressure measurements must be more than 85% of the number of measurements.During the dynamic blood pressure monitoring,the patient fills in the Neurological Deficit Symptom Checklist to record the occurrence period of the aggravation of the original symptoms and signs;record the symptoms and signs of new neurological deficits and the time of occurrence.The circadian rhythm of blood pressure is divided into super dipper type,dipper type,non-dipper type and anti-dipper type;The occurrence period of aggravation of neurological impairment was divided into six periods: ?04:00,?08:00,?12:00,?16:00,?20:00,?24:00.According to the changes of neurological deficits in patients,they were divided into exacerbated and no change groups.To analyze the circadian rhythm of blood pressure in the aggravated group and the unchanged group,as well as the main occurrence period of aggravation of neurological deficit in the aggravated group,and to further explore whether the circadian rhythm fluctuation period of blood pressure in the aggravated patients with acute cerebral infarction coincides with the main occurrence period of aggravation of neurological deficit.Results:1.Among 110 patients with acute cerebral infarction,39 had neurological deficits,71 had no change,and 35.45% had exacerbated.2.Compared with the basic data of the group with and without change,P>0.05,the difference was not statistically significant.3.The circadian rhythm distribution of blood pressure in the group with and without change was compared,P<0.01,the difference was statistically significant.Among thme,The circadian rhythm of blood pressure in the aggravated group was mainly anti-dipper type,followed by super dipper type;in the unchanged group,the circadian rhythm of blood pressure was mainly spoon type,followed by non-dipper type.4.The distribution of aggravation of neurological deficit in aggravated group at different time points was significantly different,P<0.05.The aggravation period was mainly concentrated in ?08:00,followed by ?12:00.5.The circadian rhythm fluctuation period(03:00?06:00)of anti-dipper and super-dipper abnormal blood pressure in the aggravated group basically coincided with the main occurrence period(04:00?08:00)of aggravated neurological deficits.Conclusion:1.The circadian rhythm of blood pressure in patients with aggravated neurological deficit in acute cerebral infarction is mainly anti-dipper type and super dipper type;the aggravation period was mainly between 04:00?08:00;the circadian rhythm fluctuation period of abnormal blood pressure in these patients(03:00?06:00)basically coincided with the main period of aggravation of neurological deficit(04:00?08:00).2.Clinicians should pay more attention to the changes of blood pressure at night when regulating the blood pressure of patients with acute cerebral infarction.Early active intervention should be carried out in high-risk period to reduce the abnormal fluctuation of blood pressure and maintain the normal circadian rhythm of blood pressure,avoiding further deterioration of neurological deficits as much as possible.