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Objective:To investigate the effect of psychological support during perithrombotic period on post-stroke depression (PSD) in patients with acute ischemic stroke (AIS).Methods:Patients with AIS received intravenous thrombolysis in the Affiliated Lianyungang Hospital of Xuzhou Medical University from January 1, 2021 to July 31, 2021 were enrolled prospectively. The intervention group received one-to-one individual psychological support therapy in the perithrombolytic period on the basis of receiving standard intravenous thrombolytic therapy. At 30 d after onset, Hamilton Depression Scale was used to assess whether PSD occurred. Multivariate logistic regression analysis was used to evaluate the independent influencing factor of PSD. Results:A total of 126 patients with AIS were enrolled, and 86 of them were male (68.25%). Their age was 63.65±10.46 years; 65 were in the intervention group and 61 were in the control group. The incidence of PSD in the intervention group was significantly lower than that in the control group (20.00% vs. 36.07%; χ2=4.049, P=0.044). Multivariate logistic regression analysis showed that psychological intervention (odds ratio [ OR] 0.333, 95% confidence interval [ CI] 0.132-0.838; P=0.020] was an independent protective factor for PSD, while ischemic heart disease ( OR 4.510, 95% CI 1.181-17.217; P=0.028), alcohol consumption ( OR 3.421, 95% CI 1.317-8.888; P=0.012), anticoagulation therapy ( OR 3.145, 95% CI 1.155-8.567; P=0.025) and modified Rankin Scale score before thrombolysis ( OR 1.627, 95% CI 1.142-2.317; P=0.007) were the independent risk factors for PSD. Conclusion:Perithrombolytic psychological support may reduce the incidence of PSD.
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Objective:To explore the influence of blood pressure during peri-thrombolysis period (from admission to 24 h after thrombolysis) in intracranial hemorrhage, improvement of neurological function, primary endpoint event (recurrence of symptomatic stroke) and secondary endpoint events (complex cardiovascular and cerebrovascular events, and all-cause death) in patients with acute ischemic stroke.Methods:A total of 422 patients with acute ischemic stroke who underwent intravenous thrombolysis with alteplase during hospitalization at National Center for Stroke in Lianyungang from January 2015 to March 2019 were followed up for 90 d. According to the quintile of mean systolic and diastolic blood pressures during peri-thrombolysis period, they were divided into group of blood pressure <130.00 mmHg (Q1), group of blood pressure of 130.00-140.49 mmHg (Q2), group of blood pressure of 140.50-147.99 mmHg (Q3), group of blood pressure of 148.00-158.00 mmHg (Q4), and group of blood pressure >158.00 mmHg (Q5), and group of blood pressure <71.30 mmHg (G1), group of blood pressure of 71.30-76.19 mmHg (G2), group of blood pressure of 76.20-81.89 mmHg (G3), group of blood pressure of 81.90-90.79 mmHg (G4), group of blood pressure >90.79 mmHg (G5). Univariate and multivariate Logistic regression analyse were used to evaluate the relations of blood pressure with postoperative intracranial hemorrhage and neurological function improvement. Kaplan-Meier curve, Log-rank test and multivariate Cox proportional risk model were used to evaluate the relations of blood pressure with primary endpoint event and secondary endpoint events.Results:(1) After adjusting for confounding factors, multivariate Logistic regression analysis showed that the risk of postoperative intracranial hemorrhage in patients from Q2 was significantly lower than that in patients from Q5 ( OR= 0.160, 95%CI: 0.031-0.827, P=0.029). (2) After adjusting for confounding factors, multivariate Logistic regression analysis showed that the probability of postoperative improvement of nerve function in patients from Q2 and Q3 was significantly higher than that in patients from Q5 ( OR=2.144, 95%CI: 1.043-4.407, P=0.038; OR=2.224, 95%CI: 1.105-4.479, P=0.025); the probability of postoperative improvement of nerve function in patients from G3 and G4 was significantly higher than that in patients from G5 ( OR= 2.153, 95%CI: 1.081-4.287, P=0.029; OR=2.182, 95%CI: 1.131-4.210, P=0.020). (3) After adjusting for confounding factors, multivariate Cox proportional risk model showed that the risk of primary endpoint event in patients from Q1 and Q2 was significantly lower than that in patients from Q5 ( HR=0.079, 95%CI: 0.010-0.613, P=0.015; HR=0.211, 95%CI: 0.062-0.724, P=0.013). (4) After adjusting for confounding factors, multivariate Cox proportional risk model showed that the risk of secondary endpoint events in patients from Q1, Q2, Q3 and Q4 was significantly lower than that in patients from Q5 ( HR=0.246, 95%CI: 0.100-0.607, P=0.002; HR=0.360, 95%CI: 0.177-0.732, P=0.005; HR=0.448, 95%CI: 0.246-0.817, P=0.009; HR=0.467, 95%CI: 0.252-0.867, P=0.016). Conclusion:The risks of postoperative intracranial hemorrhage, primary endpoint event and secondary endpoint events in patients with acute ischemic stroke decrease with the decrease of systolic blood pressure during peri-thrombolysis period; moderate blood pressures (systolic blood pressure: 130.00-147.99 mmHg; diastolic blood pressure:76.20-90.79 mmHg) are beneficial for improvement of neurological function.
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ObjectiveToinvestigatethecorrelationbetweenbloodpressurevariabilityandcognitive impairment in ischemic stroke. Methods The inpatients with acute ischemic stroke were enroled. The demographic and clinical data were colected. The coefficient of variation of blood pressure within 7 days after onset w as calculated. Montreal Cognitive Assessment w as used to evaluate the cognitive function at three month after onset. Multivariate logistic regression analysis w as used to identify the relationship betw een the coefficient of variation of blood pressure w ithin 7 days and the cognitive impairment at 3 months after onset. Results A total of 708 patients w ith acute ischemic stroke w ere enrol ed in the study. At 3-month folow-up, 510 patients (72.0%) had cognitive impairment and 198 (28.0%) had normal cognitive function. The coefficient of variation for systolic blood pressure ( 8.3 ±1.2 vs.8.7 ±1.4; t= -3.299, P=0.001) and coefficient of variation for diastolic blood pressure ( 7.8 ±1.3 vs.8.0 ±1.5; t= -2.529, P=0.012) in the cognitive impairment group w ere significantly higher than those in the normal cognitive function group. With the first quintile as a reference, after adjusting other confounding factors, multivariate logistic regression analysis show ed that cognitive impairment at 3 months after onset w as significantly associated w ith coefficient of variation for systolic blood pressure. The odds ratios and 95 % confidence intervals for the 2-5 quantile groups w ere 2.33 (1.18-4.6), 2.31 (1.15-4.66), 2.70 (1.29-5.65), and 4.82 (1.92-12.1), respectively ( al P<0.05 ). Conclusion Systolic blood pressure variability in the acute phase of ischemic stroke is associated w ith cognitive impairment.