急性脑梗死患者静脉溶栓前急诊生化与溶栓后早期转归及预后的关系  

The relationship between emergency biochemical indicators before intravenous thrombolysis and early clinical improvement and prognosis after thrombolysis in patients with acute ischemic stroke

作　　者：王红霞[1] 胡洪涛[1] 姜明[1] 闫立荣[1] WANG Hongxia;HU Hongtao;JIANG Ming(Department of Neurology,Beijing Jishuitan Hospital,Beijing 100096,China)

机构地区：[1]北京积水潭医院神经内科

出　　处：《中风与神经疾病杂志》2019年第9期810-814,共5页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探讨溶栓前急诊生化指标与急性脑梗死患者溶栓治疗后早期转归与预后的关系。方法2014年6月~2019年5月于北京积水潭医院经阿替普酶静脉溶栓治疗的急性缺血性卒中患者共计67例。记录患者溶栓前NIHSS评分及溶栓后24 h NIHSS评分,以二者差值(ΔNIHSS)评估早期转归:其中ΔNIHSS≥4分为显效组、1~3分为有效组、≤0分为无效组;溶栓后7 d以改良Rankin评分(mRS)记录早期预后:其中mRS评分≤2分为预后良好组、3~4分为预后一般组、5~6分为预后差组。比较上述各组间溶栓前急诊生化指标差异。计量资料以χ±s表示,使用独立样本t检验进行两样本间比较。结果(1)比较溶栓后24 h转归显效组(n=10)与无效组(n=30),有统计学差异的生化指标有:T-Bil(14.28±4.77 mmol/L vs 11.22±3.86 mmol/L,P=0.048)、血糖(6.82±1.18 mmol/L vs 8.99±4.31 mmol/L,P=0.017)。比较溶栓后24 h转归有效组(n=27)与无效组(n=30),有统计学差异的生化指标有:T-Bil(14.89±5.88 mmol/L vs 11.22±3.86 mmol/L,P=0.007)、D-Bil(4.63±1.89 mmol/L vs 3.62±1.22 mmol/L,P=0.019)、血糖(6.86±1.50 mmol/L vs 8.99±4.31 mmol/L,P=0.016)。(2)比较溶栓后7 d各预后组间溶栓前的生化指标,其中预后良好组(n=56)与预后差组(n=9)两组间溶栓前尿酸水平存在统计学差异(397±96.62 mmol/L vs 344.33±59.46 mmol/L,P=0.041)。结论溶栓前较高水平的胆红素、较低水平的血糖与溶栓后24 h早期转归更好相关,而溶栓前较高水平的尿酸与溶栓后7 d更好预后相关。Objective To discuss the relationship between emergency biochemical indicators before intravenous thrombolysis and the early clinical improvement and prognosis after intravenous thrombolysis of acute ischemic stroke.Methods From June 2014 to May 2019,67 patients with acute ischemic stroke were treated by intravenous thrombolysis with ateplase in Beijing Jishuitan Hospital.The NIHSS score before thrombolysis and 24 hours after thrombolysis were recorded,and the early clinical improvement was assessed by the difference between them(ΔNIHSS).ΔNIHSS≥4 was divided into excellent group,1-3 into effective group and≤0 into ineffective group.Early prognosis was recorded by Modified Rankin score(mRS)on 7 days after thrombolysis:mRS score(≤2)was divided into good prognosis group and 3-4 into general prognosis group and 5-6 into poor prognosis group.To compare the differences of biochemical indicators before thrombolysis among the above groups.The measurement data were expressed as mean±standard deviation(χ±SD).Independent sample t test was used to compare the two samples.Results 1.Compare the emergency biochemical indicators between the excellent group(n=10)and the ineffective group(n=30)at 24hours after thrombolysis,the indicators which have significant difference include:T-Bil(14.28±4.77 mmol/L VS 11.22±3.86 mmol/L,P=0.048),blood glucose(6.82±1.18 mmol/L VS 8.99±4.31 mmol/L,P=0.017).Compare the emergency biochemical indicators between the effective group(n=10)and the ineffective group(n=30)after thrombolysis 24hours,the indicators which have significant difference include:T-Bil(14.89±5.88 mmol/L VS 11.22±3.86 mmol/L,P=0.007),D-Bil(4.63±1.89mmol/L VS 3.62±1.22mmol/L,P=0.019),blood glucose(6.86±1.50 mmol/L VS 8.99±4.31 mmol/L,P=0.016).2.Compare the three different prognosis group at 7 days after thrombolysis.There was significant difference in uric acid level before thrombolysis between the good prognosis group(n=56)and the poor prognosis group(n=9)(397±96.62 mmol/L VS 344.33±59.46 mmol/L,P=0.041).Conc

关 键 词：急性脑梗死 静脉溶栓 急诊生化 早期转归 早期预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]