脑梗死超早期静脉溶栓治疗的疗效及相关因素分析  

Efficacy and associated factor analysis of intravenous thrombolysis in patients with early-stage acute ischemic stroke

作　　者：蔡智立 何奕涛 周致帆 陈思言 王倩 张慧 黄莹 杨苗娟 郭毅 CAI Zhili;HE Yitao;ZHOU Zhifan;CHEN Siyan;WANG Qian;ZHANG Hui;HUANG Ying;YANG Miaojuan;GUO Yi(Department of Neurology,the Second Clinical Medical College of Ji’nan University/First Affiliated Hospital of Southern University of Science and Technology/Shenzhen People's Hospital,Shenzhen 518020,China)

机构地区：[1]深圳市人民医院(暨南大学第二临床医学院,南方科技大学附属第一医院),广东深圳518020

出　　处：《中国实用神经疾病杂志》2020年第5期380-385,共6页Chinese Journal of Practical Nervous Diseases

基　　金：广东省医学科研基金面上项目(编号:A2019442)。

摘　　要：目的通过回顾性调查研究探讨脑梗死患者的基线情况与其静脉溶栓早期疗效的关系,并提出相关的建议,为静脉溶栓治疗提供参考和依据。方法以深圳市人民医院收治的249例急性脑梗死静脉溶栓治疗的患者为研究对象,收集患者基线资料,以NIHSS评分的差值作为结局变量将患者分为有效组和无效组,分析阿替普酶静脉溶栓早期的疗效及其影响因素。结果溶栓后1 h有效62例(24.90%),溶栓后24 h有效118例(47.39%),溶栓后第7天有效165例(66.27%)。溶栓1 h有效组房颤史比例、溶栓前NIHSS评分明显均低于无效组(P<0.05)。经Logistic回归分析发现,既往房颤史、溶栓前NIHSS评分是静脉溶栓1 h后影响神经功能恢复的独立因素。溶栓24 h后有效组发病至溶栓的时间(onset to treatment,OTT)、房颤史比例、溶栓前NIHSS评分、溶栓前血糖水平均低于无效组(P<0.05),经Logistic回归分析,OTT、房颤史、溶栓前血糖水平、溶栓前NIHSS评分是静脉溶栓24 h后影响神经功能恢复的独立因素。溶栓7 d后有效组OTT、溶栓前NIHSS评分均低于无效组(P<0.05),经Logistic回归分析,OTT、溶栓前NIHSS评分是静脉溶栓7 d后影响神经功能恢复的独立因素。结论阿替普酶静脉溶栓有效率随时间的推移逐渐升高。房颤史、溶栓前血糖水平、溶栓前NIHSS评分、OTT是阿替普酶静脉溶栓后早期神经功能改善的独立影响因素。Objective To evaluate the early stage efficacy and outcomes of intravenous thrombolysis(IVT)treatment in patients with acute ischemic stroke retrospectively.Methods We retrospectively reviewed 249 patients with acute stroke onset and treated with intravenous thrombolysis using alteplase(tissue plasminogen activator).The clinical characteristics of the thrombolysed patients including age,gender,weight,disease history,pre-IVT blood pressure,blood glucose and HbA1c,LDL-C,coagulation function,OTT,and NIHSS score(1h,24h,7-days after IVT)were recorded.The patients were divided into two groups depending on the changes of NIHSS scorethe effective group and the void group.Results Among all 249 patients,1 hour,24 hours and 7 days after IVT,62(24.9%),118(47.39%)and 165(66.27%)had significant decrease of NIHSS score,respectively.Among the 62 patients who have recovered after 1 hour,less of them had atrial fibrillation history and the average of pre-IVT NIHSS score is lower than the void patients(P<0.05).24 hours after IVT,lower OTT,pre-IVT blood glucose and pre-IVT NIHSS score,and less atrial fibrillation history were independent factors of efficient recovery(P<0.05).Only lower OTT and pre-IVT NIHSS score were effective independent factors for efficient recovery 7 days after IVT.Conclusion OTT,pre-IVT blood glucose and pre-IVT NIHSS score,and atrial fibrillation history may help to evaluate the functional outcome of patients with acute ischemic stroke and treated with IVT.

关 键 词：脑梗死 静脉溶栓 阿替普酶 神经功能 血糖 发病至溶栓的时间 NIHSS评分 

分 类 号：R743.33[医药卫生—神经病学与精神病学]