河南某医院脑梗死静脉溶栓治疗依从性分析  

Intravenous thrombolysis treatment compliance in patients with acute ischemic stroke in Zhengzhou University People＇ s Hospital

作　　者：赵香梅[1] 杨先芝[1] 李法良[1] 裴小溪[1] 李琳[1] 李玉成[1] 秦历杰[1] 

机构地区：[1]河南省人民医院急诊科,郑州450003

出　　处：《中华急诊医学杂志》2017年第7期784-789,共6页Chinese Journal of Emergency Medicine

基　　金：国家临床重点专科建设项目（081619232833）;河南省科技厅公关项目（142102310417）

摘　　要：目的明确河南某医院急性缺血性脑卒中患者阿替普酶（rt—PA）静脉溶栓治疗现状，分析影响患者溶栓治疗依从性的相关因素。方法前瞻性收集2014年1月至2015年12月就诊于河南省人民医院急诊科急性脑卒中患者，排除禁忌证后为分溶栓组和拒绝溶栓组，分析影响患者溶栓治疗依从性的影响因素。受试者工作特征曲线（ROC）确定患者溶栓决策的基线NIHSS评分最佳临界值。结果两年间急诊科溶栓小组评估患者共230例，排除禁忌证后，符合溶栓指征者189例，其中33例拒绝溶栓，156例接受溶栓治疗。排除禁忌证后，时间窗内到达河南省人民医院的急性梗死患者rt—PA静脉溶栓率为67．8％。影响两组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、肢体活动障碍、偏瘫、言语障碍及头晕差异有统计学意义（t=2．578，P=0．047；U=157．221，P=0．000；x^2=26．702，P=0．000；x^2=9．069，P=0．003；x^2=7．381，P=0．007；x^2=28．636，P=0．000）。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，NIHSS评分〈7分时，患者拒绝溶栓（灵敏度为0．87，特异度为0．82）。156例溶栓治疗的患者，NIHSS评分〈7分与≥7分者比较，颅内出血发生率（1．9％和3．9％，P=0．662）、住院期间及3个月病死率差异无统计学意义（1．9％和7．8％，P=0．168）、（3．8％和11．7％，P=0．142），而3个月良好预后比例更高（75．5％和41．7％，P〈0．01）。结论年龄、基线NIHSS评分、肢体活动障碍、偏瘫、言语症状和头晕影响患者静脉溶栓治疗依从性。Objective To investigate the current status about the application of alteplase （rt-PA） for intravenous thrombolysis in acute ischemic stroke patients, and clarify the relevant factors affecting patients＇ compliance of intravenous thrombolysis. Methods The acute ischemic stroke patients admitted in Department of Emergency, from January 2014 to December 2015 were recruited for study prospectively. After the patients with contraindications of thrombolysis were excluded, the eligible patients were divided into two groups, intravenous thrombolysis group （ITG） and non-intravenous thrombolysis group （NTG）. Receiver operating characteristic curve （ ROC ） was used to determine the optimal cutoff point and the crucial NIHSS score of patients for decision on thrombolysis therapy. Results There were 230 patients with acute ischemic stroke occurred in the period of two years. Of 189 eligible patients, 33 refused the intravenous thrombolysis treatment （NTG） whereas 156 willing to take the intravenous thrombolysis treatment （ITG）. The intravenous thrombolysis rate of eligible ischemic stroke patients reached to Henan Provincial People＇ s Hospital within the time window （g. 5 hours） was 67.8% without contraindications. The results of the single-factor analysis for the patients of the two groups displayed that the differences in factors including age, baseline NIHSS score, limb weakness, hemiplegic paralysis, dysphasia, as well as dizziness were significant between two groups （ t = 2. 578, P = 0. 047 ; U = 157. 221, P = 0. 000 ; x^2 = 26. 702, P = 0. 000 ; x^2=9.069, P =0.003;x^2 =7.381, P = 0.007; x^2 = 28.636, P =0.000）. The ROC analysis demonstrated the relationship between the baseline NIHSS score and the patients receiving intravenous thrombolysis. When NIHSS score 〈 7, patients tended to refuse the treatment with intravenous thrombolysis （ sensitivity 0. 87, specificity 0. 82）. Among the patients receiving intravenous thrombolysis, the significant differences in intracranial hemorrh

关 键 词：脑梗死 缺血性脑卒中 组织型纤溶酶原激活物 溶栓治疗 

分 类 号：R743.33[医药卫生—神经病学与精神病学]