Résumé
Objective The explore the effect of blood pressure bundle management on prognosis of patients with acute ischemic stroke after intravenous thrombolysis. Methods A total of 286 acute ischemic stroke patients, who received intravenous thrombolytic therapy in Stroke Center of our hospital between Oct. 1, 2015 and Mar. 31, 2018, were included in this study. The patients who received blood pressure bundle management after intravenous thrombolysis were assigned to bundle group, and the patients without blood pressure bundle management were in control group. The baseline data, National Institutes of Health stroke scale (NIHSS) score on admission, blood pressure before thrombolysis, the incidence of symptomatic intracranial hemorrhage and the in-hospital mortality after thrombolysis, and the 90-d modified Rankin scale (mRS) score were compared between the two groups. Multivariate logistic regression analysis was used to explore the effect of blood pressure bundle management, NIHSS score, onset-to-needle time, and blood pressure on prognosis of patients. Results Of 286 patients with acute ischemic stroke, 161 patients were in bundle group, and 125 patients were in control group. There were no significant differences in age, gender, hypertension, diabetes mellitus, atrial fibrillation, NIHSS score on admission or blood pressure before thrombolysis between the two groups (all P0.05). The incidence of symptomatic intracranial hemorrhage was significantly lower in the bundle group than that in the control group (2.48% [4/161] vs 8.00% [10/125], χ2＝4.598, P＝0.032). There was no significant difference in the in-hospital mortality between the two groups (3.73% [6/161] vs 3.20% [4/125], χ2＝0.058, P＝0.810). The 90-d good prognosis (mRS score 0-2) rate was significantly higher in the bundle group than that in the control group (62.11% [100/161] vs 49.60% [62/125], χ2＝4.485, P＝0.034). Successive variation of systolic blood pressure and successive variation of diastolic blood pressure were significantly lower in the bundle group than those in the control group ([13.37±4.92] mmHg [1 mmHg＝0.133 kPa] vs [18.42±3.87] mmHg, t＝2.437, P＝0.025; [11.23±4.02] mmHg vs [15.48±5.16] mmHg, t＝1.842, P＝0.046). Multivariate logistic regression analysis showed that blood pressure bundle management (odds ratio [OR]＝0.798, P＝0.002) and successive variation of diastolic blood pressure≤15 mmHg (OR＝0.816, P＝0.018) were independent predictors for good prognosis of acute ischemic stroke patients with intravenous thrombolysis. Conclusion Blood pressure bundle management can improve blood pressure variation of the patients with acute ischemic stroke after receiving intravenous thrombolysis, reduce the incidence of symptomatic intracranial hemorrhage and improve the prognosis of the patients.