基线NIHSS评分与急性脑梗死静脉溶栓预后的相关性研究  

The correlation between baseline of NIHSS score and therapeutic outcomes for intravenous thrombolysis in stroke patients

作　　者：贺利峰[1] 刘恺鸣[2] 王亚仙[1] 沈双[1] 

机构地区：[1]浙江省湖州市中心医院神经内科,浙江湖州313000 [2]浙江大学医学院附属第二医院神经内科,浙江杭州310009

出　　处：《中国现代医生》2016年第13期20-23,共4页China Modern Doctor

基　　金：浙江省自然科学基金青年基金项目(LQ15H090003)

摘　　要：目的 探讨美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale,NIHSS）基线评分的高低对急性脑梗塞患者应用重组组织型纤溶酶原激活物（rt-PA）静脉溶栓预后的影响。方法 回顾性分析2012年1月～2014年6月开展急性脑梗死rt-PA静脉溶栓52例患者的临床资料,按溶栓前NIHSS评分高低,分为A组4～7分16例,B组8～13分22例,C组14～25分14例,以NIHSS评分下降率评价近期疗效,以日常生活能力的评定（Barthel）指数（BI）评价生活质量,以改良Rankin量表（m RS）评分评价预后。结果 三组治疗后2 h、24 h、7 d NIHSS评分均较治疗前好转（P〈0.05）;各时间点NIHSS评分下降率B组高于其他两组（P〈0.05）;治疗后24 h有效率B组高于其他两组（86.4%vs 75.0%、57.1%）（P〈0.05）;三组治疗后90 d BI评分均较治疗前升高（P〈0.05）,其中B组显著高于其他两组（P〈0.05）;治疗后90 d m RS评分良好率B组优于其他两组（P〈0.05）;治疗期间C组不良反应发生率高于其他两组（P〈0.05）。结论 治疗前NIHSS评分在8～13分者行静脉溶栓后近期及远期疗效优于其他两组,不良反应发生率未增加。Objective To investigate the relationship between baseline NIHSS score and therapeutic outcomes of intravenous thrombolysis in stroke patients. Methods Retrospectively analysis the clinical data of intravenous thrombolysis with rt-PA in 52 acute stroke patients from January 2012 to June 2014. According to the NIHSS score before thrombolysis, 52 patients were divided into three groups： group A（n=16,NIHSS 4-7）, group B（n=22,NIHSS 8-13）, and group C（n=14,NIHSS 14-25）. The decline rate of NIHSS score was used to evaluate the recent effect. Barthel index （BI） was used to evaluate the quality of life, the modified Rankin scale （mRS） score was used to evaluate the prognosis. Results After 2 h, 24 h and 7 d of treatment, NIHSS scores in three groups were all higher than before treatment（P〈 0.05）; NIHSS score decline rate of group B was higher than the others at each time point（P〈0.05）; The effectiveness of 24 h after treatment of group B was higher than others（P〈0.05）; The BI of 90 d after treatment of the three groups was increased than before （P〈0.05）, among them the score of group B was significantly higher than the other two groups （P〈0.05）; the mRS score rate of 90 d after treatment of group B was better than others （P〈0.05）; During treatment the incidence of adverse reactions in group C was higher than other two groups（P〈0.05）. Conclusion Therapeutic outcomes of i：~travenous thrombolysis in patients with 8 to 13 points of NHISS score have a better outcome than others, and the incidence of adverse reactions was not increasing.

关 键 词：急性脑梗死 静脉溶栓 RT-PA NIHSS评分 

分 类 号：R743.3[医药卫生—神经病学与精神病学]