80岁及以上急性脑梗死患者静脉溶栓的预后影响因素分析  

Risk factors for the outcomes in ≥80 years old ACI patients after intravenous thrombolysis

作　　者：徐伟[1,2] 李辉萍[3] 王振[1] 贺国华[1] 胡珏 童洋萍[1] 李芳毅[1] 宋康平 刘新峰 Xu Wei;Li Huiping;Wang Zhen;He Guohua;Hu Jue;Tong Yangping;Li Fangyi;Song Kangping;Liu Xinfeng(Department of Neurology,Affiliated Changsha Central Hospital of South China University,Changsha 410004,Hunan Province,China)

机构地区：[1]长沙市中心医院南华大学附属长沙中心医院神经内科,410004 [2]南方医科大学附属金陵医院神经内科 [3]湖南省人民医院湖南师范大学附属第一医院康复科

出　　处：《中华老年心脑血管病杂志》2022年第5期507-511,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：湖南省卫生健康委科研计划项目(202103070273,20201939);长沙市科技计划项目(kzd2001068;kq1901016);南华大学附属长沙中心医院科研项目(YNKY202005)。

摘　　要：目的 探讨年龄≥80岁的急性脑梗死(ACI)患者静脉溶栓(IVT)治疗的预后影响因素。方法 回顾性纳入2016年1月~2021年3月在长沙市中心医院神经内科接受IVT治疗的老年ACI患者397例,分为≥80岁组92例和60~79岁组305例。比较2组临床资料和预后。采用多因素logistic回归评估症状性出血转化(SHT)以及3个月不良预后的独立危险因素。结果 与60~79岁组比较,≥80岁组冠心病、心房颤动、心力衰竭、SHT、卒中相关性肺炎(SAP)比例,基线美国国立卫生研究院卒中量表(NIHSS)评分及3个月改良的Rankin量表评分明显升高,良好预后比例和血清白蛋白水平明显降低(P<0.05,P<0.01)。多因素logistic回归分析显示,基线NIHSS评分5~14分、基线NIHSS评分≥15分、SHT、心力衰竭及SAP是3个月预后不良的独立危险因素(P<0.05,P<0.01)。基线NIHSS评分≥15分(OR=1.414,95%CI:1.150~1.740,P<0.01),血清白蛋白水平(OR=0.836,95%CI:0.745~0.937,P<0.01)是SHT的独立危险因素,而年龄≥80岁不是SHT以及3个月不良预后的独立危险因素(P>0.05)。结论 基线NIHSS评分、SHT、心力衰竭以及SAP是老年ACI患者IVT治疗3个月不良预后的独立危险因素,而年龄≥80岁并不是SHT以及不良预后的独立危险因素。Objective To study the risk factors for the outcomes in ≥80 years old ACI patients after intravenous thrombolysis(IVT).Methods Three hundred and ninety-seven elderly ACI patients who underwent IVT in our hospital from January 2016 to March 2021 were divided into ≥80 years old group(n=92) and 60-79 years old group(n=305).The baseline clinical data, complications and clinical outcomes were compared between the two groups.The independent risk factors of symptomatic hemorrnagic transformation(SHT) and poor outcome in elderly ACI patients after 3 months of IVT were analyzed by multivariate logistic regression analysis.Results The incidence of CHD,AF,HF,SHT,stroke-associated pneumonia(SAP),baseline NIHSS score and mRS score at month 3 after IVT were significantly higher while the ratio of poor outcome was significantly lower in ≥80 years old group than in 60-79 years old group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that baseline NIHSS score=5-14,baseline NIHSS score≥15,SHT,HF and SAP were independent risk factors for the poor outcome in elderly ACI patients at month 3 after IVT(P<0.01,P<0.05) while baseline NIHSS score≥15 and serum albumin level were independent risk factors for SHT in elderly ACI patients at month 3 after IVT(OR=1.414,95%CI:1.150-1.740,P<0.01;OR=0.836,95%CI:0.745-0.937,P<0.01),but age≥80 years was not an independent risk factor for SHT and poor outcome in elderly ACI patients at month 3 after IVT(P>0.05).Conclusion Baseline NIHSS score, SHT,HF and SAP are independent risk factors while age≥80 years is not an independent risk factor for SHT and poor outcome in elderly ACI patients at month 3 after IVT.

关 键 词：脑梗死 血栓溶解疗法 冠心病 心房颤动 心力衰竭 组织型纤溶酶原激活物 

分 类 号：R743.3[医药卫生—神经病学与精神病学]