静脉溶栓治疗急性缺血性脑卒中患者的临床预后影响因素  

Influencing factors of clinical prognosis in patients with acute ischemic stroke treated with intravenous thrombolysis

作　　者：吴国新 何家成 刘之钰[1] 叶镱[1] 冯垣波 吴智鑫[2] 关紫云[1] WU Guo-xin;HE Jia-cheng;LIU Zhi-yu;YE Yi;FENG Yuan-bo;WU Zhi-xin;GUAN Zi-yun(Department of Emergency,Foshan Nanhai District People′s Hospital,Guangdong Province,Foshan 528200,China;ICU,Foshan Traditional Chinese Medicine Hospital,Guangdong Province,Foshan 528200,China)

机构地区：[1]广东省佛山市南海区人民医院急诊科,广东佛山528200 [2]广东省佛山市中医院重症监护室,广东佛山528200

出　　处：《中国当代医药》2021年第16期79-81,92,共4页China Modern Medicine

基　　金：广东省医学科学技术研究基金项目(A2019185);广东省佛山市十三五医学重点专科和特色专科建设项目(FSTSZK010);广东省佛山市科技创新项目(2017AG100082)。

摘　　要：目的探讨静脉溶栓治疗急性缺血性脑卒中患者的临床预后影响因素。方法回顾性选取2017年10月~2019年10月南海区人民医院收治的260例急性缺血性脑卒中患者作为研究对象,按照溶栓的临床结局改良效果分为预后良好组(130例)和预后不良组(130例)。两组均给予阿替普酶治疗,比较两组的神经缺损评分,并分析影响急性缺血性脑卒中预后的因素。结果治疗2 d、1周、1个月后,预后不良组的神经功能缺损评分均高于预后良好组患者,差异有统计学意义(P<0.05)。单因素分析结果提示,两组的年龄、体重、高血压史、住院时间、糖尿病史、心房颤动史、溶栓前收缩压比较,差异有统计学意义(P<0.05);多因素分析结果提示,年龄≥60岁(β=1.457,OR=4.257,95%CI=2.365~6.954)、体重≥65 kg(β=0.684,OR=5.236,95%CI=1.028~5.687)、住院时间≥10 d(β=0.747,OR=5.326,95%CI=4.395~7.893)、高血压史(β=1.442,OR=4.091,95%CI=3.235~4.573)、糖尿病史(β=1.573,OR=6.413,95%CI=5.691~8.461)、心房颤动史(β=1.131,OR=4.574,95%CI=1.496~9.481)、溶栓前收缩压≥140 mmHg(β=1.215,OR=3.591,95%CI=2.491~6.324)是急性缺血性脑卒中患者的预后不良的危险因素(P<0.05)。结论静脉溶栓治疗急性缺血性脑卒中的临床效果显著,可降低患者的神经缺损情况,针对急性缺血性脑卒中患者预后不良的危险因素需积极干预,以提高患者的生命质量。Objective To investigate the clinical prognostic factors of patients with acute ischemic stroke treated with intravenous thrombolysis.Methods A total of 260 patients with acute ischemic stroke admitted to People′s Hospital of Nanhai District from October 2017 to October 2019 were retrospectively selected as the research subjects.According to the improved clinical outcome of thrombolysis,the patients were divided into good prognosis group(130 cases)and poor prognosis group(130 cases),and both groups were treated with Alteplase.The nerve defect scores of the two groups were compared,and the factors affecting the prognosis of acute ischemic stroke were analyzed.Results After 2 d,1 week and 1 month of treatment,neurological deficit scores in the poor prognosis group were higher than those in the good prognosis group,the difference was statistically significant(P<0.05).Univariate analysis results indicated that age,weight,history of hypertension,length of hospital stay,history of diabetes mellitus,history of atrial fibrillation and systolic blood pressure before thrombolysis were compared between the two groups,the differences were statistically significant(P<0.05).Multivariate analysis indicated that age≥60 years old(β=1.457,OR=4.257,95%CI=2.365-6.954),body weight≥65 kg(β=0.684,OR=5.236,95%CI=1.028-5.687),length of hospital stay≥10 d(β=0.747,OR=5.326,95%CI=4.395-7.893),history of hypertension(β=1.442,OR=4.091,95%CI=3.235-4.573),history of diabetes(β=1.573,OR=6.413,95%CI=5.691-8.461),history of atrial fibrillation(β=1.131,OR=4.574,95%CI=1.496-9.481)and systolic blood pressure before thrombolysis≥140 mmHg(β=1.215,OR=3.591,95%CI=2.491-6.324)were risk factors for poor prognosis in patients with acute ischemic stroke(P<0.05).Conclusion The clinical effect of intravenous thrombolysis in the treatment of acute ischemic stroke is significant,which can reduce the nerve defect in patients.The risk factors for poor prognosis in patients with acute ischemic stroke need active intervention to improve the quality

关 键 词：静脉溶栓 急性缺血性脑卒中 预后影响 多因素分析 临床分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]