????????????????????????

Abstract:ObjectiveTo explore the predictive value of blood pressure variability(BPV)for the prognosis after thrombectomy in patients with acute ischemic stroke(AIS).MethodsA total of 173 patients with acute ischemic stroke(AIS)who underwent mechanicalthrombectomyattheFirst People'sHospital of Lianyungang from January 2021to December 2O22 were retrospectivelyincluded.The blood presuredata within7days after the operation were collected，and the coefficient of variation(CV)ofbloodpressure and the slope( m )ofdynamic changes were calculated.Theassociation between BPVandprognosis through multivariate logisticregressionanalysiswas evaluated.ResultsUnivariate analysis showed that BPV，age，scores onadmission，etc.were associated with the prognosis(all ).Multivariate regression analysis indicated that m was an independent predictor of poor prognosis( OR=1.038 ， 95% CI=1.013-1.054 )，suggesting that for every 1% increase in m ，the risk of poor prognosis increased by 3.8% . The receiver operating characteristic(ROC) curve showed that the area under curve (AUC)of m was 0.824.When the cut-off value was 8.61，the sensitivity was O.712 and the specificity was 0.912 : ConclusionsBPV is an effctive predictor of poor prognosis after thrombectomy in patients with acute ischemic stroke.Monitoring and controling postoperative blood pressure fluctuations，particularly BPV，can improve patient outcomes and provide robust clinical management guidance.

Key words:acute ischemic stroke;mechanical thrombectomy;blood pressure variability;outcome;influencing factor

????????(acuteischemicstroke，AIS)??????????，?????(endovasculartreatment，EVT)???????????????????????DEFUSE3?DAWN???EVT?????? 24h^[1] ，??????????? EVT^[1] ，????????? 50% ，??????????????????????????????(? lt;180mmHg )，????????(bloodpressurevariability，BPV)??????BPV??????????????，???????????????[2-4]???????????????BPV????[5-6]，??EVT??????????????????2021?1?-2022?12????????????????173?AIS??，?????????????? (m) ，??BPV????????????，??????????????????

1?????

1.1???????173?AIS??，???125?，?48?;??58~73?，????67???????Logistic??????，??????[7](???? OR=1.2~ 1.5)，?? ?=0.05 ?????0.8，??? 150~160 ??????173?????，??????????????(? 80% )?????:(1)??????????????????，??????????;(2)??????????????? 24h ;(3)????18~85?;(4)?????Rankin??(modifiedRankinscale，mRS)?? ?1 ?，?????????????;(5)??????(????????????????)??????????(?????????，???????????????????);(6???????;(7)???????????????????????，??????????????:(1)??????????????????(computedtomography，CT)?????????????????;(2)?????????????;(3)??????????，???????????????;(4)????????????????(modifiedthrombolysisincerebralinfarction，mTICI)?????2b?????;(5)????????????;(6)??????????，???????????????????????????(???:LW-20250221001-01)???????????????????????，??????????????????????

1.2??

1.2.1????????????(?????)????????(???????????)?????(CTP/MRI)???????????????????????1.2.2?????????????????，?????????????????????，????????????，??????????????1.2.3???????????7d????????0~24h :? ??; 24~72h :?6h??; 72h~7d :?12h????? 24h.48h.72h.7 d??????????? ? ????? (m) ?1.2.4???????????????????????，??????????(??????????)，????????????(?????????? ??24h )????????????，??????;??????????，???????????(?????????????)???(?? ?15min )?????????，??? 2min ??????，????(???? ?^6h 24h )???????????????20???，??????(?? lt;5min )，??????(intraclasscorrelationcoefficient，I) gt;0.90 ;???????????????1.2.5???????????????(coefficientofvariation，CV)???????????????，???????????????(standarddeviation，SD)???????????(systolicbloodpressure，SBP)???，??

?????????:

??， ?_SD ????????????，Mean SBP ????????????

1.2.6 ? ?????? (m) ??? ? ????????? ?CV=CV_i+1-CV_i ，?? CV_i ??? i ????????;?CV_i ??? i ? i+1 ????????????" ? ???"????????????????????，????????7d?????，" ? ???"??????????????????????????，?? ? ?????????，?????????????????，?????，????? y=mx+b ??? ?_m ???，???????????????， b ???，?????? x=0 ???????? mgt;0 ，???????????，??????; mlt;0 ，???????????，???????

1.2.7?????????????????????CT?????????????，???????????????，??????????????????????

1.3???????mTICI??:2b~3???????， 0~2a ???????? 90dmRS ??:??0~6?，0~2????????，3~5????????，6?????????????????????????? 90d ?mRS???mRS?????????????????????，??????????????????: ???0~2?????????????????????，????，???????????( n=104 )??????: mRS ???3~6??????????????????，?????????，????( n=69 )?

1.4???????????SPSS26.0?????????，???????????????? ? ?????，?????????? ?_t ???????;?????????????????????，??????????????;???????????? (%) ??，?????????? ?² ???????????????，????????????????Logistic????，???????????，? Plt;0.05 ????????

2??

2.1????????????????(???????????)???????，?????????( ??3~6)?????(?1)????????，??????????????????????????:??(?²=4.31，P=0.038 )???? (?²=3.92，P=0.048 )???(? (Z=2.35，P=0.024 )?ASPECT??( Z=3.56，Plt;0.01 )???NIHSS( Z=2 .53， P=0. 012 )?DPT( Z=2.54，P= 0.013)?DRT( Z=2.35 T P=0.022 )????? ?=2.01，P= 0.045)???( Z=2.56，P=0.013 )?

2.2???????????????????( Plt;0.05)?????Logistic????，???????????????????，?? ? ?????????? (m) ????????????， m ??? 1% ，??????????? 3.8% ????????????????NIHSS?????????????CT??(AlbertaStroke

ProgramEarlyCTScore，ASPECTS)DPT?DRT??????????????，??2??????????? ?(m) ??????(0)，??? (m) ??????????????(1)??，???? (m) ???????????(?1)?

2.3??( m )????????????(receiveroperatingcharacteristic，ROC)??????? ?(m) ??????????ROC??????，?????(areaundercurve，AUC)?( ).824(95%CI=0.752~0.895，Plt; 0.001)，?????????????????Youden???????????8.61，??????0.712，????0.912，??Youden???0.624???????????????????，????????????2?

2.4??????????????????? ?(m) ????????????????( OR ?1.038)，???????????????，????????????????????????，?? ?65 ???( n=93 )?， OR ??(1.040)，????????????????????????????????? lt;65 ????， OR ?1.031，??????? P ???，???????????OR=1.042 ，???????;???( n=48 ) OR=1.029 P=0.066 ，????????????，?????????????????????????3?

2.5???????????????，??????????????????????????????:(1)????????1?;(2)???????(?????????????)2?;(3)? 24h ????????(??????)2???????173?，????5?，??????168?，?????????4?

????，??? OR=1.038，95% CI=1.013~1.054 ，??? OR=1.031，95%CI=1.008~1.050 ，???????，????????? ?(m) ???????????????????????????????????????，????????????NIHSS???，??????????????????????????????????，??????????(?5?)，?? ?(m) ???AIS????????????????????????，?????????????

3??

BPV???????????????，???????????????????，??????????，??????????????，????????????????，?????????????????，????????7d?，?????????????????????????，BPV????????????????????????????????，????????????????????[10-11]????????，BPV?????????????，????????????????????，????BPV????????????[12-17]

?????????????， m ????????????????????????BPV????????????，????????????????????????????????BPV?????，????，??????????????，?????????????[18-24]???? BPV ?????????????，????????????，?BPV????????????"????"，????????????????????????????，???????????，???????????????，???????????[25-31]?

?????????，????????????????????，?????? ?(m) ?????????????? mgt;0 ，???????????，??????;mlt;0 ，???????????，?????????，??????????????，???????????????，????????????????????，?????????????????

?????????，??，???????????????( n=160 )，???????????????，????????????????，??????，????????????????????????????，?????????????????????????????????????????[32-33]，?????????????(?????????????????)??????????????;?????????????????????????????，????????????????????????????????????????，???????????????????，????????

??，??????????????????:(1)???????:???????? 24~72h ????????????????，????????????????;(2)????:???????????，????"???"?"???"???"???"，?????????????????????;(3)???????:??????????????????????，????????????????????????;(4)????:???????????????，???????????，?????(???)????????，???????

?????，BPV???? (m) ???????????????????????， m ??? 1% ??????3.8% ?????????????，?????，???????????????????????????????，???????????????????????，???????

????:???????????????

??????:???????????????????;??????????????;??????????;???????????????

[????]

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