急性基底动脉闭塞溶栓早期临床预后分析  

The early Outcomes and associated factors in patients with acute basilar occlusion with thrombolysis

作　　者：徐安定[1] 唐敬敬[1] 李牧[1] 辛秀峰[1] 杨万勇[1] 刘小艳[1] 

机构地区：[1]暨南大学脑科学研究所暨南大学附属第一医院神经内科,广州510630

出　　处：《中国神经精神疾病杂志》2012年第5期289-293,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：国家科技部十二五科技支撑计划课题"脑血管病急性期诊疗技术规范化应用和医疗质量评价与持续改进技术研究(编号:2011BAI08B02);暨南大学附属第一医院重点建设学科(群)建设(心脑血管疾病学科群)基金2010年

摘　　要：目的评估急性基底动脉闭塞(basilar artery occlusion,BAO)患者溶栓后早期临床预后及其影响因素。方法总结我院2003年至2011年15例急性BAO溶栓患者资料,分析其早期预后及影响因素。其中早期不良预后指标为出院时死亡或植物生存,早期良好预后指标为改良Rankin评分0～2分。结果 15例急性BAO溶栓患者,重组组织型纤溶酶原激活剂动脉溶栓8例、静脉溶栓4例,尿激酶动脉溶栓2例、动静脉联合溶栓1例。其中早期不良预后6例(40%)、早期良好预后5例(33%),与国内外报道最佳结果相近。发生2例症状性颅内出血,均死亡。早期不良预后者年龄和基线收缩压明显高于对照组(76±5岁,64±11岁,P=0.011;171±18 mmHg,145±22 mmHg,P=0.039),基线神经功能缺损评分更高(NIHSS 29.2±9.2,17.9±11.5),发病至溶栓时间更长(中位时间82.79 h,9.00 h),二者均接近统计学差异边缘(P=0.077)。结论急性BAO患者应尽可能溶栓;症状性颅内出血、高龄、高基线血压和神经功能缺损评分、发病至溶栓时间延长与其早期不良预后可能有关。Objective To evaluate the early outcomes and associated factors in patients with acute basilar artery occlusion（BAO） with thrombolysis.Methods The clinical data of consecutive patients with acute BAO with thrombolysis in our hospital during 2003 ～ 2011 were retrospectively analyzed.Death or vegetative state at discharge was considered as early poor outcome whereas modified Rankin Scale 0 ～ 2 at discharge was regarded as good early outcomes.Results The present study included 8 patients with acute BAO with intra-arterial recombinant tissue plasminogen activator（rt-PA）,4 patients with intravenous,rt-PA,2 patients with intra-arterial urokinase and 1 patients with a combination of intra-arterial and intravenous urokinase.Six cases（40%） had early poor outcomes whereas 5 cases（33%） had good early outcome.Two cases died from symptomatic intracranial hemorrhage [sICH,NIH Stroke Scale（NIHSS） increase ≥4 points].Patients with poor early outcomes tended to have older age（76 ± 5 y,64 ± 11 y,P = 0.011）,higher baseline systolic blood pressure（171 ± 18mmHg,145 ± 22 mmHg,P = 0.039）,high NIHSS（NIHSS 29.2 ± 9.2,17.9 ± 11.5,P = 0.077） and longer onset to start of treatment time（median time 82.79 h,9.00 h,P = 0.077）.Conclusions Patients with acute BAO should be administered with thrombolysis as much as possible.sICH,older age,higher baseline blood pressure and NIHSS,as well as longer OTT may associated with early poor outcomes.

关 键 词：急性基底动脉闭塞 溶栓 早期预后 

分 类 号：R743.32[医药卫生—神经病学与精神病学] R743.33[医药卫生—临床医学]