急性缺血性脑卒中早期神经功能恶化的影响因素  

Factors related to early neurological deterioration in acute ischemic stroke

作　　者：董秋艳[1] 樊丽娟[1] 苏慧[1] 白智华[1] DONG Qiuyan, FANG Lijuan, SU Hui, and BAI Zhihua(Third Department of Internal Medicine, Second Hospital of Beijing Munic- ipal Crops ,Chinese People＇s Armed Police Force, Beijing 100037 ,Chin)

机构地区：[1]武警北京总队第二医院内三科,100037

出　　处：《武警医学》2018年第1期21-24,共4页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的探讨急性缺血性脑卒中早期神经功能恶化(early neurological deterioration,END)的影响因素。方法回顾性分析在时间窗内的急性缺血性脑卒中分别采用单纯静脉溶栓与桥接治疗的患者112例,入院治疗后连续3 d行神经功能检查,根据有无END分为END组及非END组,比较两组患者入院时的临床资料。将P<0.2的观察指标纳入Logistic回归模型(Forward法)以确定急性缺血性脑卒中患者发生END的相关影响因素。结果 112例中,34例(30.4%)有END,为END组,其余78例为非END组。P<0.2的指标包括性别、来院到开始治疗的时间、治疗前神经功能评分(NIHSS评分)、血糖、总胆固醇、合并糖尿病、不同治疗方式(静脉溶栓与桥接治疗)。二元Logistic回归分析结果显示,不同治疗方式(OR=6.67,95%CI1.24~34.93,P=0.025)、血脂水平(总胆固醇、HDL及LDL)(OR=1.03,95%CI 1.01~1.06,P=0.034)及糖尿病控制情况(既往糖尿病及空腹血糖水平)(OR=1.16,95%CI 1.03~1.31,P=0.017)是END的独立预测因素。结论不同治疗方式、血糖水平及血脂代谢异常是急性缺血性脑梗死患者发生END的相关因素。Objective To investigate the effects of intravenous thrombolytic therapy and bridging therapy on early neurological deterioration（END） during acute ischemic stroke. Methods The clinical data on 112 patients with acute ischemic stroke who were treated with the intravenous thrombolytic therapy or the bridging therapy within the time window was retrospectively analyzed. These patients were subjected to three days of neurofunctional examinations after admission before they were divided into the END group and the non-END group according to the occurrence of END. The clinical data of the two groups was compared upon admission,including gender,age,hypertension,blood lipids,blood glucose and complications. Observation indexes（P 0. 2） were entered into the binary Logistic regression analysis model to identify factors associated with END in case of acute inchemic stroke. Results Among the 112 cases of patients with acute ischemic cerebral infarction,there were 34 cases of END（30. 4%）. Indexes P 0. 2 included gender,the interval between admission and treatment,pre-treatment neurologic function score（NIHSS）,blood glucose,total cholesterol,complications with diabetes mellitus,and different therapies. The binary Logistic regression analysis suggested that according to the results of different treatments（OR = 6. 67,95% CI 1. 24-34. 93,P = 0. 025）,lipid levels（total cholesterol,HDL and LDL）（OR = 1. 03,95% CI 1. 01-1. 06,P = 0. 034） diabetes control（a history of diabetes and fasting blood glucose levels）（OR = 1. 16,95% CI 1. 03-1. 31,P = 0. 017）were independent predictors of END. Conclusions Different treatments,blood glucose levels and blood lipid metabolic abnormalities in patients with acute ischemic cerebral infarction are factors related to END.

关 键 词：急性缺血性脑梗死 静脉溶栓 桥接治疗 早期神经功能恶化 

分 类 号：R743[医药卫生—神经病学与精神病学]