The relationship between blood pressure variability and ST-T change of electrocardiogram and the severity of acute cerebral infarction and their influence on prognosis / 中国医师进修杂志

ABSTRACT

Objective:To investigate the relationship between blood pressure variability and ST-T changes of electrocardiogram and the severity of acute cerebral infarction (ACI) and their influence on the prognosis.Methods:A total of 80 ACI patients who diagnosed and treated from February 2018 to February 2020 in Ningbo Medical Center Li Huili Hospital were selected as the research subjects. According the National Institutes of Health Stroke Scale (NIHSS) score, they were divided into mild group (0-15 scores, 31 cases) and moderate group (16-30 scores, 27 cases), severe group (31-45 scores, 22 cases), the changes of ischemic ST-T and blood pressure variation were compared among the three groups, the correlation between ST-T changes, blood pressure variation and disease severity were analyzed by Kendall (tau-b) method. According the results of Modified Rankin Scale(mRS), the ACI patients were divided into the good prognosis group (mRS≤2 scores, 63 cases) and the poor prognosis group (mRS>2 scores, 17 cases). The Logistic regression model was used to analyze the risk factors affecting the prognosis.Results:The ST-T changes among the mild group, moderate group and severe group had significant differences ( P<0.05); the persistent ST-T changes rate in the mild group, moderate group was lower than that in the severe group 3.23%(1/31), 14.81%(4/27) vs. 59.09%(13/22), P<0.05. The daytime mean systolic blood pressure standard deviation (dSBPSD), nocturnal systolic blood pressure standard deviation (nSBPSD) in the severe group were significantly higher than those in the mild group and moderate group (14.41 ± 3.22) mmHg (1 mmHg = 0.133 kPa) vs. (11.54 ± 3.02), (12.95 ± 4.52) mmHg;(13.19 ± 3.52) mmHg vs. (10.02 ± 1.65), (11.45 ± 2.45) mmHg, there were statistical differences ( P<0.05). The results of Kendall(tau-b) correlation analysis showed that dSBPSD, dDBPSD, nSBPSD and ischemic ST-T were positively correlated with severity ( r = 0.275, 0.251, 0.334, 0.440; P<0.05). Logistic regression analysis showed that age>70 years old, complete anterior circulation infarction/partial anterior circulation infarction of Oxfordshire Community Stroke Project (OCSP) classification, severe/moderate disease severity, large infarct/small infarct size, persistent ST changes/transient ST-T changes, as well as high levels of 24 h mean systolic blood pressure, 24 h systolic standard deviation, 24 h mean diastolic blood pressure and 24 h diastolic standard deviation were risk factors for poor prognosis in ACI patients. Conclusions:The ST-T changes and blood pressure variability of ACI patients will change with the severity of the disease. Monitoring the changes is helpful to provide an important reference for prognostic judgment.