急性缺血性卒中静脉溶栓后早期神经功能恶化影响因素分析  

The neurological deterioration in the early period after intravenous thrombolysis in acute ischemic stroke analysis of factors affecting

作　　者：郑健 李春艳[1] 马丹 韩剑虹[1] ZHENG Jian;LI Chunyan;MA Dan;HAN Jianhong(Department of Neurology,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China)

机构地区：[1]昆明医科大学第二附属医院神经内科,650101

出　　处：《中国老年保健医学》2024年第3期65-70,74,共7页Chinese Journal of Geriatric Care

基　　金：云南省科技厅应用基础计划项目(编号:202201AT070241);云南省教育厅科学研究基金(编号:2023Y0813)。

摘　　要：目的探索急性缺血性脑卒中(AIS)患者接受静脉溶栓治疗后,出现早期神经功能恶化(END)的影响因素。方法回顾性分析2022年1月至2023年6月连续住院的急性缺血性脑卒中溶栓患者,根据所选溶栓药物的不同分为尿激酶(UK)组33例和阿替普酶(rt-PA)组116例。根据静脉溶栓后是否发生早期神经功能恶化(溶栓后24小时内NIHSS评分较入院时升高≥2分或死亡)分为早期神经功能恶化组和非早期神经功能恶化组。早期神经功能恶化的危险因素分析使用单因素分析和Logistic回归分析,绘制ROC曲线。结果与非早期神经功能恶化组相比,早期神经功能恶化组入院时的随机血糖、超敏-C反应蛋白(hs-CRP)、入院时卒中量表(NIHSS)评分及溶栓后24小时颅内出血比例更高,且入院时的随机血糖、入院时NIHSS评分是静脉溶栓后发生早期神经功能恶化的独立危险因素。结论入院时的随机血糖、入院时NIHSS评分可作为急性缺血性脑卒中静脉溶栓后发生早期神经功能恶化的预测因素,静脉溶栓前NIHSS评分高、入院时随机血糖高的患者发生早期神经功能恶化的风险更大。Objective Exploration in patients with acute ischemic stroke(AIS),after intravenous thrombolysis treatment in early neurologic deterioration(END)the influence of the factors.Methods Consecutive patients hospitalized for thrombolysis in AIS from January 2022 to June 2023 were retrospectively analyzed and divided into 33 cases in the urokinase thrombolytic drug(UK)group and 116 cases in the alteplase(rt-PA)group according to the different thrombolytic drugs.The END group and the non-END group were categorized according to whether END occurred after intravenous thrombolysis(NIHSS score≥2 points higher than at admission within 24h of thrombolysis or death).Risk factors for END were analyzed using univariate and logistic regression analyses and ROC curves were plotted.Results In contrast to the non-END group,the END group had higher rates of random blood glucose,hypersensitive C-reactive protein(hs-CRP),NIHSS score at admission and intracranial hemorrhage 24 hours after thrombolysis,in addition,random blood glucose on admission,and NIHSS scores on admission were independent risk elements for the development of END after intravenous thrombolysis.Conclusion Random blood glucose at admission and NIHSS score at admission can be used as predictors of END after AIS intravenous thrombolysis.Patients with high NIHSS scores prior to intravenous thrombolysis and high randomized blood glucose on admission are at greater risk of END.

关 键 词：急性缺血性脑卒中 早期神经功能恶化 静脉溶栓 影响因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]