Effect Of Intravenous Thrombolysis On The Prognosis Of Patients With Acute Ischemic Stroke (AIS)

Background and objective:Acute cerebral infarction is one of the most common diseases in neurology.Intravenous thrombolysis is the best drug for the treatment of AIS.A number of studies at home and abroad have proved that the reduction of blood pressure in patients with thrombolysis in the acute phase may be beneficial to the prognosis of patients,but there is still a debate on whether to strengthen or standard blood pressure reduction.The purpose of this study is to explore the correlation between the average blood pressure in the perioperative thrombolytic period and the prognosis,and to explore the blood pressure range most conducive to the prognosis.Methods: A total of 228 patients with AIS who were hospitalized in Affiliated Hospital of Yan’an University in September 2019 and who were treated with intravenous thrombolysis alone in September-2021 were retrospectively reviewed.After collecting their basic parameters(age,gender,height,weight),risk factors of cerebrovascular disease(hypertension,diabetes,history of atrial fibrillation,stroke history,etc.),thrombolysis data were collected.The prognosis was evaluated according to the discharge 90 dmrs score(modified Rankin score)and intracranial hemorrhage.From low to high,the patients were divided into four groups according to the quartile method.Firstly,whether the baseline data of each group were statistically significant was analyzed;Secondly,univariate logistic regression was used to find the risk factors,multivariate analysis was included to adjust the confounding factors,and then the optimal range of blood pressure was obtained.Results:1.Through the analysis of baseline data,the overall differences between different blood pressure groups in gender,age,history of hypertension,smoking history,intracranial artery stenosis and average blood pressure in the perioperative thrombolytic period were statistically significant.(P<0.05)2.After univariate logistic regression analysis,age,history of hypertension,NIHSS score after thrombolysis,NIHSS score for 24 hours after thrombolysis,intracranial artery stenosis and average blood pressure in the perioperative period were the risk factors affecting the prognosis of patients.3.Explore the optimal blood pressure range: take Q4/G4/P4 as the reference group,and use the multivariate logistic regression model to correct the confounding factors.The result is that for the four groups of systolic blood pressure,the probability of no improvement of neurological function in Q2 group(127.57-137.29mmhg)is0.162 times higher than that in Q4 group(> 149.00mmhg),and the difference is statistically significant.(or = 0.162,95% CI 0.064-0.408,P = 0.002)there was no significant difference between the other two groups and Q4 group.In terms of intracranial hemorrhage,the risk of intracranial hemorrhage in Q1,Q2 and Q3 groups was 0.089,0.988 and 0.229 times higher than that in Q4 group respectively,but there was no significant difference between Q1 group and Q4 group.There was significant difference in diastolic blood pressure in group g20-904(95% or = 890.089-95%hg-0.083)(P = 890.083)(or = 890.083)(P = 0.083)(P = 0.083)(or = 0.088)(P =0.083)(or = 0.088)(P = 0.083)(or = 0.088)(P = 0.083)(or = 0.080)(P = 0.083)(or =0.084)(P = 0.080)(or = 0.083)(P = 0)(or = 0.001).Based on the grouping of pulse pressure difference,the difference between P1 group(< 49.09mmhg)and P4 group(>61.11mmhg)was statistically significant.(OR=2.739 95%CI 1.064-7.054 P=0.037)Conclusions:1.The mean blood pressure during thrombolytic period is an independent risk factor for the improvement of neurological function and intracranial hemorrhage,and is significantly correlated with the prognosis.(P<0.01)2.The ideal blood pressure range obtained from the study is systolic blood pressure 127.57-137.29 mmhg and diastolic blood pressure less than 75.59 mm Hg.3.Age,history of hypertension,blood pressure during thrombolysis,NIHSS score after thrombolysis,24 h NIHSS score and intracranial vascular stenosis are independent risk factors affecting the prognosis of patients,among which NIHSS score after thrombolysis is one of the important influencing factors,which deserves attention.