常压高浓度氧联合静脉溶栓治疗不同病因分型前循环急性缺血性卒中患者的有效性及安全性  

Efficacy and safety analysis of intravenous thrombolysis combined with normobaric hyperoxia in the treatment of different etiological calssifications of acute ischemic stroke in anterior circulation

作　　者：李娜[1,2] 吴隆飞[1] 赵文博 李伟力[1] 吴雅丽 谢云燕 吉训明[3] Li Na;Wu Longfei;Zhao Wenbo;Li Weili;Wu Yali;Xie Yunyan;Ji Xunming(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;不详)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053 [2]北京市仁和医院老年科,102600 [3]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国脑血管病杂志》2022年第7期443-450,共8页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金资助项目(81620108011)。

摘　　要：目的探讨常压高浓度氧(NBO)联合重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗不同病因分型前循环急性缺血性卒中患者的有效性及安全性。方法回顾性连续纳入2019年1月1日至12月31日期间于首都医科大学宣武医院神经内科接受NBO联合rt-PA静脉溶栓治疗的发病4.5 h内的前循环急性缺血性卒中患者。根据急性卒中Org10172治疗试验(TOAST)分型,将所有患者分为大动脉粥样硬化组和非大动脉粥样硬化组(包括心源性栓塞型、小动脉闭塞型、其他明确病因型和不明原因型)。比较两组患者的基线资料及主要结局和次要结局。主要结局定义为发病后90 d功能独立[改良Rankin量表(mRS)评分0~2分]患者的比例。次要结局分为有效性结局[发病后90 d功能极好(mRS评分≤1分)和溶栓后即刻、24 h及发病后7 d美国国立卫生研究院卒中量表(NIHSS)评分及发病后7 d梗死体积]和安全性结局(非症状性颅内出血、症状性颅内出血、发病后7 d症状加重、并发症、发病后90 d死亡)。应用多因素Logistic回归分析方法分析不同病因分型与发病后90 d功能独立的相关性。结果共111例接受NBO联合rt-PA静脉溶栓治疗的前循环急性缺血性卒中患者纳入本研究,其中大动脉粥样硬化组68例,非大动脉粥样硬化组43例。(1)大动脉粥样硬化组高血压病患者比例、血糖值均高于非大动脉粥样硬化组,差异均有统计学意义(均P<0.05)。(2)大动脉粥样硬化组与非大动脉粥样硬化组发病后90 d功能独立患者的比例差异无统计学意义[76.5%(52/68)比83.7%(36/43),P=0.36]。(3)发病后7 d大动脉粥样硬化组梗死体积大于非大动脉粥样硬化组[18.9(6.5,34.1)cm 3比8.6(4.6,23.8)cm 3],组间差异有统计学意义(P=0.03);余有效性结局和安全性结局事件组间差异均无统计学意义(均P>0.05)。(3)多因素Logistic回归分析结果表明,TOAST分型与发病后90 d功能是否独立不相关(OR=1.1Objective To explore the efficacy and safety of recombinant tissue-type plasminogen activator(rt-PA)intravenous thrombolysis combined with normobaric hyperoxia(NBO)in the treatment of different etiological classification of acute ischemic stroke(AIS)in anterior circulation.Methods Anterior circulation AIS patients who received NBO combined with rt-PA within 4.5 hours from stroke onset at the Neurology Department of Xuanwu Hospital,Capital Medical University from January 1 st to December 31 st,2019 were retrospectively included.These patients were divided into large-artery atherosclerosis group and non-large-artery atherosclerosis(including cardioembolism,small artery occlusion,stroke of other determined etiology and stroke of undetermined etiology)group based on the trial of Org 10172 in acute stroke treatment(TOAST)classification.The baseline data and outcomes were compared between the two groups.The primary outcome was the proportion of functional independence(modified Rankin Scale[mRS]scores 0-2)at 90 days after onset.Secondary outcomes were efficacy outcomes(excellent functional independence[mRS score≤1]90-day after onset,National Institute of Health stroke scale[NIHSS]scores immediately and 24 h after intravenous thrombolysis as well as 7-day after onset,and infarc volume 7-day after onset)and safety outcomes(asymptomatic and symptomatic intracranial hemorrhage,aggravation of symptoms 7 days after onset,complications and death in 90 days after onset).Multivariable Logistic regression analysis was used to analyze the relevance between TOAST classification and functional independence 90 days after onset.Results A total of 111 anterior circulation AIS patients treated with NBO combined with rt-PA were included in this study.There were 68 patients with large-artery atherosclerosis and 43 patients with non-large-artery atherosclerosis.Consequently,(1)The proportion of patients with hypertension and glucose levels in the large-artery atherosclerotic group were higher than those in the non-large-artery atheroscle

关 键 词：卒中 神经保护 溶栓 常压高浓度氧治疗 病因分型 

分 类 号：R743.3[医药卫生—神经病学与精神病学]