Orta serebral arter enfarktüslü hastalarda trombolitik tedavi sırasındaki kan basıncı düzeyleri ile fonksiyonel sonuçlar arasındaki ilişki

Amaç: Önceki çalışmalar, intravenöz (IV) trombolitik tedavi öncesi ve sonrası kan basıncı (KB) düzeyi ile akut iskemik inme (Aİİ)’nin fonksiyonel sonuçları arasındaki ilişkiyi araştırmıştır. Bununla birlikte, trombolitik infüzyonu sırasındaki KB düzeyi ile fonksiyonel sonuçlar arasındaki ilişki iyi araştırılmamıştır. Bu nedenle, bu çalışmada orta serebral arter (MCA) enfarktüslü Aİİ hastalarında trombolitik tedavi sırasındaki KB düzeyleri ile 3.’üncü aydaki fonksiyonel sonuçlar arasındaki ilişki araştırıldı.Yöntemler: Bu vaka-kontrol çalışması, MCA'nın 1/3'ünden daha büyük enfarktüsü olan 60 hasta üzerinde gerçekleştirildi. Bunlardan 20’si aydınlatılmış onam alındıktan sonra IV trombolitik tedavi yapılmış hastalardı (çalışma grubu). Trombolitik tedavisi yapılmayan 40 hastada da kontrol grubu olarak alındı. IV trombolitik tedavi yapılan hastalar 3.’üncü aydaki modifiye Rankin Skalasına (mRS) göre iki gruba ayrıldı: iyi fonksiyonel sonuç (mRS skoru=0-2) ve kötü fonksiyonel sonuç (mRS skoru=3-6).Bulgular: Kötü fonksiyonel sonuç grubu iyi fonksiyonel sonuç grubuna göre daha yüksek ortalama diyastolik KB’ye sahipti (P=0,01). İyi fonksiyonel sonuç grubunda sistolik KB <140 mmHg ve diyastolik KB <75 mmHg idi. Acil servise girişteki (r=0,679; P=0,001), IV trombolitik infüzyonundan hemen önceki (r=0,580; P=0,007) ve infüzyon sırasındaki ortalama diyastolik KB düzeyleri (r=0,643; P=0,002) ile mRS arasında anlamlı, pozitif ve orta düzeyde bir korelasyon vardı.Sonuç: MCA enfarktüslü Aİİ hastalarında, IV trombolitik tedavi sırasındaki yüksek diyastolik KB düzeyleri kötü fonksiyonel sonuçlarla ilişkilidir.

Anahtar Kelimeler:

Akut iskemik inme, Kan basıncı, İntravenöz trombolitik tedavi, Orta serebral arter enfarktüsü, Fonksiyonel sonuçlar, Modifiye Rankin skalası

Relationship between blood pressure levels during thrombolytic therapy and functional outcomes in patients with middle cerebral artery infarction

Aim: Previous studies have investigated the relationship between blood pressure (BP) level before and after intravenous (IV) thrombolytic therapy, and functional outcomes of acute ischemic stroke (AIS). However, the relationship between BP level during thrombolytic infusion and functional outcomes has not been well studied. Therefore, in this study, we investigated the relationship between BP levels during thrombolytic therapy and functional outcomes at the 3rd month in AIS patients with middle cerebral artery (MCA) infarction.Methods: This case-control study was conducted on 60 patients with infarcts in more than 1/3 of MCA. Among these, 20 patients underwent IV thrombolytic therapy after giving informed consent (study group). Forty patients who did not receive thrombolytic therapy were included in the control group. Patients undergoing IV thrombolytic therapy were divided into two groups according to modified Rankin Scale (mRS) at the 3rd month: Those with good functional outcomes (mRS score=0–2) and poor functional outcome (mRS score=3–6). Results: The poor functional outcome group had a higher mean diastolic BP than the good functional outcome group (P=0.01). Systolic BP was <140 mmHg and diastolic BP was <75 mmHg in the good functional outcome group. A significant, positive, and moderate correlation was found between the mRS score and diastolic BP at the time of admission to the emergency department (r=0.679, P=0.001), immediately before (r=0.580, P=0.007), and during IV thrombolytic therapy (r=0.643, P=0.002). Conclusion: In AIS patients with MCA infarction, high diastolic BP levels during IV thrombolytic therapy are associated with poor functional outcomes.

Keywords:

Acute ischemic stroke, Blood pressure, Intravenous thrombolytic therapy, Middle cerebral artery infarction, Functional outcomes, Modified Rankin scale,

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