关键词: 急性缺血性脑卒中, 静脉溶栓, 血压, 溶栓后出血

Abstract:

Objective To monitor and analyze the association between 24-hour blood pressure and bleeding complications in patients with acute ischemic stroke after intravenous thrombolysis,for predicting bleeding complications with possible blood pressure range and monitoring time.Methods Totally 487 patients with acute ischemic stroke who were admitted to four stroke centers in Beijing from June 2015 to December 2017 were enrolled and received rt-PA intravenous thrombolysis. Demographic data,blood pressure before thrombolysis,blood pressure within 24 hours after thrombolysis,imaging examination during bleeding,and laboratory inspection data were collected and analyzed.Results A total of 168 patients（34.5%） had bleeding complications. The baseline blood pressure of patients with bleeding complications was higher than that of patients with non-bleeding complications,and the difference was statistically significant（P<0.05）. The optimal blood pressure monitoring time for systemic hemorrhage,intracranial hemorrhage and gingival hemorrhage was before thrombolysis or during thrombolysis. Respiratory hemorrhage occurred early after thrombolysis,while nasal and urinary hemorrhage occurred about 12 hours after thrombolysis. The threshold values of blood pressure were 146/81.5 mmHg（systemic hemorrhage）,159.5/108.5 mmHg（intracranial hemorrhage）,159.5/85 mmHg（gingival hemorrhage）,184/87.5 mmHg（nasal hemorrhage）,143.5/100.5 mmHg（respiratory hemorrhage）,136.5./91.5 mmHg（urinary hemorrhage）,respectively.Conclusion High blood pressure within 24 hours after thrombolysis is risk factor for hemorrhage. Bleeding complications with possible blood pressure range and monitoring time provide basis for nursing observation.

Key words: Acute Ischemic Stroke, Intravenous Thrombolysis, Blood Pressure, Bleeding Complications