重组组织型纤溶酶原激活物静脉溶栓治疗腔隙性脑梗死患者的临床疗效及患者预后的影响因素研究  

Clinical Efficacy of Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator in the Treatment of Lacunar Cerebral Infarction and the Influencing Factors of Patients'Prognosis

作　　者：张艳玲 唐兴江 郭晓燕 邓瑶 ZHANG Yanling;TANG Xingjiang;GUO Xiaoyan;DENG Yao(Department of Neurology,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院神经内科,四川省泸州市646000 [2]四川省德阳市人民医院神经内科

出　　处：《实用心脑肺血管病杂志》2020年第9期40-45,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：背景目前,腔隙性脑梗死(LACI)患者采用静脉溶栓治疗是否获益仍存在争议。目的分析重组组织型纤溶酶原激活物(rt-PA)静脉溶栓治疗LACI患者的临床疗效及患者预后的影响因素。方法选取2016年1月—2019年7月西南医科大学附属医院收治的急性缺血性脑卒中患者305例,其中采用静脉溶栓治疗患者148例,LACI患者205例。根据OSCP分型标准将静脉溶栓治疗患者分为LACI组(n=48)和non-LACI组(n=100);根据治疗方式将LACI患者分为静脉溶栓组(n=48)和非静脉溶栓组(n=157);根据LACI患者预后情况分为预后良好(n=97)和预后不良(n=108)。静脉溶栓患者发病4.5 h内给予rt-PA治疗,非静脉溶栓患者于入院24 h内给予抗血小板聚集药物治疗。比较LACI组和non-LACI组、静脉溶栓组和非静脉溶栓组患者一般资料、实验室检查指标、治疗效果及预后,预后良好和预后不良患者一般资料、实验室检查指标、治疗效果、治疗方式。LACI患者预后的影响因素分析采用多因素Logistic回归分析。结果LACI组患者糖尿病、有效溶栓反应、出院后3个月改良Ranking量表(mRS)评分≤2分、出院后3个月mRS评分≤1分者所占比例及Alberta卒中项目早期CT评分(ASPECTS)高于non-LACI组,发病至入院时间、发病至溶栓时间、住院时间短于non-LACI组,入院时美国国立卫生研究院卒中量表(NIHSS)评分、血小板平均体积、出院时mRS评分及心房颤动、大脑中动脉高密度征、颅内出血、死亡者所占比例低于non-LACI组(P<0.05)。静脉溶栓组患者入院时NIHSS评分、出院时mRS评分低于非静脉溶栓组,其他部位出血、出院后3个月mRS评分≤2分、出院后3个月mRS评分≤1分者所占比例高于非静脉溶栓组,住院时间短于非静脉溶栓组(P<0.05)。预后良好患者入院时NIHSS评分低于预后不良患者,住院时间短于预后不良患者,静脉溶栓者所占比例高于预后不良患者(P<0.05)。多因素LogisticBackground At present,the benefit of intravenous thrombolysis in the treatment of patients with lacunar cerebral infarction(LACI)is still controversial.Objective To analyze the clinical efficacy of intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in the treatment of LACI and the influencing factors of patients'prognosis.Methods A total of 305 cases with acute cerebral infarction were selected from the Affiliated Hospital of Southwest Medical University from January 2016 to July 2019,including 148 patients treated with intravenous thrombolysis and 205 patients with LACI.Patients with intravenous thrombolysis were divided into LACI group(n=48)and non-LACI group(n=100)according to OSCP diagnostic criteria;LACI patients were divided into intravenous thrombolysis group(n=48)and non-intravenous thrombolysis group(n=157)according to treatment method;LACI patients were divided into good prognosis(n=97)and poor prognosis(n=108)according to prognosis.Patients with intravenous thrombolysis received rt-PA within 4.5 hours of onset,while patients without intravenous thrombolysis received antiplatelet aggregation drugs within 24 hours of admission.General date,laboratory inspection indexes,therapeutic outcome and prognosis were compared between LACI group and non-LACI group,intravenous thrombolysis group and non-intravenous thrombolysis group;and general date,laboratory inspection indexes,therapeutic outcome and treatment method were compared between good prognosis patients and poor prognosis patients.Multivariate Logistic regression analysis was used to analyze the influencing factors of prognosis of patients with LACI.Results Proportion of diabetes mellitus,effective intravenous thrombolysis,mRS score 3 months after discharge≤2 and mRS score 3 months after discharge≤1 and ASPECTS in LACI group were statistically significantly higher than those in non-LACI group,time of onset to admission,time of onset to thrombolysis,hospital stays in LACI group were statistically significantly shorter than th

关 键 词：腔隙性脑梗死 静脉溶栓 重组组织型纤溶酶原激活物 改良Ranking量表 预后 影响因素分析 

分 类 号：R743.33[医药卫生—神经病学与精神病学]