急性缺血性卒中围静脉溶栓时间窗临床症状波动的静脉溶栓研究  

Intravenous Thrombolysis for Acute Ischemic Stroke Patients with Fluctuating Clinical Symptoms in the Perivenous Thrombolysis Time Window

作　　者：陈忠伦[1] 张杉杉[1] 张献文[1] 李肇坤[1] 浦明军 都泓材 段劲峰[1] CHEN Zhong-Lun;ZHANG Shan-Shan;ZHANG Xian-Wen;LI Zhao-Kun;PU Ming-Jun;DU Hong-Cai;DUAN Jin-Feng(Department of Neurology,Mianyang Central Hospital,Mianyang 621000,China)

机构地区：[1]绵阳市中心医院神经内科,绵阳621000

出　　处：《中国卒中杂志》2020年第9期1010-1014,共5页Chinese Journal of Stroke

摘　　要：目的探讨急性缺血性卒中患者围静脉溶栓时间窗临床症状波动的患者进行静脉溶栓治疗的临床特征及预后分析。方法前瞻性纳入绵阳市中心医院2013年10月-2018年6月连续登记的发病4.5 h内进行静脉溶栓的患者,以实施静脉溶栓时NIHSS评分较入院时NIHSS评分上下波动2分作为临床症状波动判断标准,将所有纳入患者分为无变化组、波动组。分析比较两组患者的临床特征及24 h出血转化率、出院NIHSS评分、3个月预后良好(mRS评分≤2分)和全因死亡率,多因素Logistic回归分析围静脉溶栓时间窗发生临床症状波动的影响因素。结果共纳入156例,其中男性110例(70.5%),年龄范围42~87岁,平均65±13岁,发生围静脉溶栓时间窗临床症状波动41例(26.3%)。与无变化组患者相比,波动组患者年龄、基线NIHSS评分、糖尿病比例、高血压比例、随机血糖水平、后循环梗死比例较高,差异均具有统计学意义。两组患者的24 h出血转化率、出院NI HSS评分、3个月良好预后率、3个月时全因死亡率差异无统计学意义。Logistic回归分析发现年龄(每增加10岁:OR 1.143,95%CI 1.016~1.836,P=0.040)、基线NIHSS评分(每增加1分:OR 1.353,95%CI 1.053~1.393,P=0.006)、随机血糖(每增加1 mmol/L:OR 2.120,95%CI 1.185~2.748,P=0.001)、后循环梗死(OR 2.603,95%CI 1.037~3.950,P=0.042)是围静脉溶栓时间窗临床症状波动的独立危险因素。结论尽管高龄、NIHSS评分高、血糖水平高、后循环梗死患者容易出现围静脉溶栓时间窗临床症状波动,但对终点事件并无影响。对于出现临床症状波动的患者,溶栓可使患者获益。Objective To investigate the clinical characteristics and prognosis of thrombolytic therapy for acute ischemic stroke(AIS)patients with fluctuating clinical symptoms in the perivenous thrombolytic time window.Methods Data of consecutive AIS patients who underwent intravenous thrombolysis within 4.5 hours of stroke onset in Mianyang Central Hospital from October 2013 to June 2018 from stroke registry database were analyzed.Clinical symptom fluctuation was defined as the NIHSS score fluctuating≥2 points(increase or decrease)at the time of intravenous thrombolysis compared to at admission.All the patients were divided into no change group and fluctuation group.The clinical features,24-hour hemorrhagic transformation,NIHSS score at discharge,90-day good prognosis(mRS≤2),and all-cause mortality were compared between the two groups.Multivariate logistic regression analysis was used to analyze the factors affecting the clinical symptom fluctuation.Results A total of 156 patients were included,with a mean age of 65±13 years old(range:42-87years)and 110 males(70.5%),and 41 patients(26.3%)in fluctuation group.Compared to the no change group,the fluctuation group had higher age,NIHSS score at admission,percentage of diabetes and hypertension and posterior circulation infarction,and random blood glucose level(all P<0.05).The rate of hemorrhagic transformation,the NIHSS score at discharge,the rate of patients with 90-day good prognosis and all-cause mortality had no statistical difference between the two groups.Multivariate analysis showed that age(per 10-year increase:OR 1.143,95%CI 1.016-1.836,P=0.040),NIHSS score at admission(OR 1.353,95%CI 1.053-1.393,P=0.006),random blood glucose level(OR 2.120,95%CI 1.185-2.748,P=0.001),posterior circulation infarction(OR 2.603,95%CI 1.037-3.950,P=0.042)were independent risk factors for clinical symptom fluctuation in the perivenous thrombolytic time window.Conclusions Although patients with elder age,high NIHSS score at admission,high blood glucose level,and posterior circulation

关 键 词：卒中 静脉溶栓 时间窗 临床症状波动 

分 类 号：R743.3[医药卫生—神经病学与精神病学]