醒后脑卒中静脉溶栓的安全性和有效性分析  

Analysis of the safety and efficacy of intravenous thrombolysis in wake-up stroke

作　　者：李宁 张圣 潘雪微 耿昱[2] 马小董 Li Ning;Zhang Sheng;Pan Xuewei;Geng Yu;Ma Xiaodong(The Second Clinical Medical College of Zhejiang Chinese Medical University,Hangzhou 310053,China;Department of Neurology,Zhejiang Provincial People's Hospital,Hangzhou 310016,China;Department of Neurology,Haiyan People's Hospital,Jiaxing 314300,China)

机构地区：[1]浙江中医药大学第二临床医学院,杭州310053 [2]浙江省人民医院神经内科,杭州310016 [3]浙江省海盐县人民医院神经内科,314300

出　　处：《心脑血管病防治》2023年第5期12-16,共5页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的通过与“时间窗”内接受静脉溶栓治疗的急性缺血性脑卒中(AIS)患者比较,研究基于弥散加权成像(DWI)与液体衰减反转恢复序列(FLAIR)不匹配指导下醒后脑卒中(WUS)患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓的安全性和临床疗效。方法回顾性分析2020年1月至2022年9月间在浙江省人民医院和海盐县人民医院卒中中心接受rt-PA静脉溶栓治疗的AIS患者,根据发病时间是否明确分为WUS组与标准治疗组(发病<4.5 h),记录并比较两组人群rt-PA静脉溶栓后的安全性和有效性。安全性终点为症状性颅内出血(sICH)的发生率;有效性终点为发病后90 d时预后不良[改良Rankin评分(mRS)>2分]的发生率。采用多因素Logistic回归分析确定sICH和90 d预后不良的影响因素。结果共纳入284例AIS患者,WUS组63例(22.2%),标准治疗组221例(77.8%)。与标准治疗组相比,WUS组入院至静脉溶栓时间(DNT)更长及舒张压更高,差异有统计学意义(P<0.05)。WUS组和标准治疗组患者发病后90 d预后不良比例差异有统计学意义(χ^(2)=5.324,P<0.05),两组sICH发生率差异无统计学意义(χ^(2)=0.864,P>0.05)。与预后良好组相比,预后不良组患者的年龄较大,基线美国国立卫生研究院卒中量表(NIHSS)评分更高,DNT更长,男性、小动脉闭塞型以及不明原因型比例较低,高血压、心房颤动、脑卒中相关性肺炎(SAP)、脑实质出血、sICH、大动脉粥样硬化型及心源性栓塞型比例较高(P<0.05)。多因素Logistic回归分析显示,基线NIHSS评分、年龄以及SAP是90 d预后不良的影响因素[OR(95%CI)=1.204(1.114~1.302)、1.059(1.018~1.101)、4.962(1.535~16.035),P<0.01],而WUS静脉溶栓对90 d预后不良无独立影响作用。结论DWI/FLAIR不匹配指导WUS患者静脉溶栓的安全性和有效性不劣于“时间窗”内静脉溶栓治疗。Objective Through the comparison with acute ischemic stroke(AIS)patients who received intravenous thrombolysis within the time window,to evaluate the safety and efficacy of intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rt-PA)in patients with wake-up stroke(WUS)guided by the mismatch between diffusion-weighted imaging(DWI)and fluidattenuated inversion recovery(FLAIR).Methods A retrospective analysis was conducted on AIS patients who received rt-PA intravenous thrombolysis at the stroke centers of Zhejiang Provincial People's Hospital and Haiyan People's Hospital from January 2020 to September 2022.According to the time of onset,patients were divided into the WUS group and the standard treatment group(onset<4.5 h).The safety and efficacy of rt-PA intravenous thrombolysis were recorded and compared between the two groups.The endpoint of safety was the incidence of symptomatic intracranial hemorrhage(sICH),while the endpoint of efficacy was the incidence of poor prognosis[the modified Rankin Scale(mRS)score>2]at 90 days after onset.Multivariate logistic regression analysis was used to determine the independent risk factors for sICH and poor prognosis at 90 days.Results A total of 284 AIS patients were included,with 63 cases(22.2%)in the WUS group and 221 cases(77.8%)in the standard treatment group.Compared with the standard treatment group,the WUS group had a longer door-to-needle time(DNT)and higher diastolic blood pressure,with statistically significant differences(P<0.05).There was a statistically significant difference in the proportion of patients with poor prognosis 90 days after onset between the WUS group and the standard treatment group(χ^(2)=5.324,P<0.05),while there was no significant difference in the incidence of sICH between the two groups(χ^(2)=0.864,P>0.05).Compared with the good prognosis group,patients in the poor prognosis group were older,had higher baseline National Institutes of Health Stroke Scale(NIHSS)score,longer DNT,lower proportion of male,small artery oc

关 键 词：醒后脑卒中 急性缺血性脑卒中 静脉溶栓 磁共振成像 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]