华山医院急性脑梗死患者阿替普酶静脉溶栓治疗依从性分析  

Intravenous thrombolysis treatment compliance with alteplase in patients with acute ischemic stroke in Huashan Hospital

作　　者：杨璐萌[1] 程忻[1] 凌倚峰[1] 曹文杰[1] 吴斐[1] 方堃[1] 董强[1] 

机构地区：[1]复旦大学附属华山医院神经内科,上海200040

出　　处：《中华神经科杂志》2015年第10期845-849,共5页Chinese Journal of Neurology

基　　金：上海市科委西医引导类项目（124119a8100）;上海市公共卫生体系建设三年行动计划项目（GW3-18）

摘　　要：目的 明确华山医院神经内科急性缺血性脑卒中患者阿替普酶静脉溶栓治疗率,分析影响患者静脉溶栓治疗依从性的相关因素.方法 前瞻性连续收集2014年1-12月华山医院神经内科急诊疑似急性脑卒中和短暂性脑缺血发作患者,排除禁忌证后,按照是否溶栓治疗分组比较,寻找影响患者溶栓治疗依从性的相关因素.结果 2014年1-12月华山医院溶栓团队急诊评估患者共220例,排除禁忌证后,43例患者拒绝溶栓,59例接受溶栓治疗.在两组患者中影响患者是否接受溶栓治疗的单因素分析结果显示,年龄、基线NIHSS评分、肢体无力、偏瘫、面瘫或言语症状差异有统计学意义（U=936.000,P=0.024;U=284.500,P＜0.01;χ^2=8.824,P=0.003;χ^2=7.732,P=0.005;χ^2=5.169,P=0.038;χ^2 =5.040,P=0.025）.受试者工作特征曲线分析显示基线NIHSS评分与患者是否接受溶栓治疗有关,基线NIHSS评分＜7分时,患者拒绝溶栓（敏感度0.93,特异度0.71）.进一步分析2008年1月至2014年12月华山医院急性缺血性脑卒中患者接受静脉溶栓治疗244例,NIHSS评分＜7分的患者与NIHSS评分≥7分患者相比,颅内出血发生率（分别为2.6％、19.4％;χ^2=12.466,P＜0.01）、7d病死率（分别为1.3％、16.9％;χ^2=12.308,P＜0.01）及3个月病死率（分别为3.8％、21.1％;χ^2=11.993,P＜0.01）更低,而3个月良好预后比例更高（分别为78.2％、38.0％;χ^2 =34.403,P＜0.01）.结论 排除溶栓禁忌后,时间窗内到达华山医院的急性缺血性脑卒中患者阿替普酶静脉溶栓率54.6％.年龄、基线NIHSS评分、肢体无力、偏瘫、面瘫和言语症状等因素影响患者静脉溶栓治疗依从性.轻症缺血性卒中患者静脉溶栓治疗的有效性高,安全性好.Objective To clarify the intravenous thrombolysis utilization of acute ischemic stroke patients in Huashan hospital,and to analyze the factors affecting thrombolytic therapy compliance.Methods The data from a prospective cohort were analyzed.Consecutive acute stroke and transient ischemic attack patients from Huashan Hospital emergency room were recruited in 2014.Eligible ischemic stroke patients were divided into two groups according to intravenous thrombolysis or not.Results Totally 220 patients from emergency room were assessed in 2014.Among eligible patients,43 patients refused intravenous thrombolysis,whereas 59 patients chose this therapy.After multiple analysis,age,baseline NIHSS score,limb weakness,hemiplegic paralysis,facial paralysis or speech symptoms were significantly different between the two groups （U =936.000,P =0.024;U =284.500,P 〈 0.01;χ^2 =8.824,P =0.003;χ^2 =7.732,P=0.005;χ^2 =5.169,P=0.038;χ^2 =5.040,P=0.025）.Patients with NIHSS score 〈7 tended to refuse thrombolysis therapy in the receiver operating characteristic curve analysis （sensitivity 0.93,specificity 0.71）.From 2008 to 2014,244 cases were analyzed in the thrombolysis database.Compared with patients with higher baseline NIHSS score,intracranial hemorrhage rate （2.6% vs 19.4%;χ^2 =12.466,P 〈0.01）,7-day mortality rate （1.3% vs 16.9%;χ^2 =12.308,P 〈0.01） and 3-month mortality rate （3.8% vs 21.1%;χ^2 =11.993,P 〈0.01） were lower in patients whose baseline NIHSS score 〈 7 （minor group）.A higher rate of excellent outcome （3-month modified Rankin Scale score ≤ 1）was observed in minor group （78.2% vs 38.0%;χ^2 =34.403,P 〈 0.01）.Conclusions Intravenous thrombolysis was performed in 54.6% of eligible ischemic stroke patients.Age,baseline NIHSS score,limb weakness,hemiplegic paralysis,facial paralysis or speech symptoms were associated with patients＇ decision of thrombolysis.The effectiveness and safety of intravenous thrombolysis were promising for patients with mild stroke.

关 键 词：脑梗死 组织型纤溶酶原激活物 血栓溶解疗法 

分 类 号：R743.3[医药卫生—神经病学与精神病学]