时间窗内rt-PA溶栓治疗急性脑梗死后早期神经功能恶化的危险因素分析  

Analysis of risk factors for early neurological deterioration after acute cerebral infarction treated with rt-PA thrombolysis within the time window

作　　者：章子骏 付杰 韩静霆 Zhang Zi-jun;Fu Jie;Han Jing-ting(Department of Neurology,Shangrao People's Hospital,Shangrao 334000,Jiangxi,China)

机构地区：[1]上饶市人民医院神经内科,江西上饶334000

出　　处：《四川生理科学杂志》2024年第8期1810-1812,共3页

摘　　要：目的:探究时间窗内重组组织型纤溶酶原激活剂(Recombinant tissue plasminogen activator,rt-PA)溶栓治疗急性脑梗死后早期神经功能恶化(Early neurological deterioration,END)的危险因素。方法:选取2022年1月至2023年12月于我院rt-PA溶栓治疗的急性脑梗死患者81例,所有患者均在发病4.5 h内接受治疗,根据是否在溶栓24 h内出现END,将患者分为恶化组和未恶化组,比较两组患者临床资料,分析rt-PA溶栓治疗后END的危险因素。结果:rt-PA溶栓24 h后出现END 19例,未出现END 72例,恶化组rt-PA溶栓24 h后美国国立卫生院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分高于未恶化组(P<0.05);恶化组年龄≥60岁、合并冠心病、发病至溶栓时间3~4.5 h发生率及入院NIHSS评分、入院白细胞计数(White blood cell,WBC)、入院血糖水平均高于未恶化组(P<0.05);Logistic二元回归方程结果显示,年龄≥60岁、合并冠心病、入院NIHSS评分、入院WBC、入院血糖水平均为时间窗内rt-PA溶栓后END的危险因素(P<0.05)。结论:年龄、合并冠心病、入院NIHSS评分、WBC、血糖水平为时间窗内rt-PA溶栓后END的危险因素,需引起临床足够重视。Objective:To explore the risk factors for early neurological deterioration(END)after acute cerebral infarction(ACI)treated with recombinant tissue plasminogen activator(rt-PA)thrombolysis within the time window.Methods:A total of 81 patients with ACI who were treated with rt-PA thrombolysis in the hospital were selected from January 2022 to December 2023.All patients were treated within 4.5 hours of onset.According to whether END occurred within 24 hours of thrombolysis,the patients were divided into deterioration group and non-deterioration group,and the clinical data were compared.The risk factors of END after rt-PA thrombolysis were analyzed.Results:19 cases developed END and 72 cases did not develop END after 24 hours of rt-PA thrombolysis.The score of National Institutes of Health Stroke Scale(NIHSS)at 24 hours of rt-PA thrombolysis in deterioration group was higher than that in non-deterioration group(P<0.05).The age≥60 years old,coronary heart disease,time from onset to thrombolysis of 3-4.5 hours,NIHSS score at admission,white blood cell count(WBC)at admission,and blood glucose at admission in deterioration group were higher than those in non-deterioration group(P<0.05).Logistic binary regression equation showed that age≥60 years old,coronary heart disease,NIHSS score at admission,WBC at admission,and blood glucose level at admission were all risk factors for END after rt-PA thrombolysis within the time window(P<0.05).Conclusion:Age,coronary heart disease,and NIHSS score,WBC and blood glucose at admission are the risk factors for END after rt-PA thrombolysis within the time window,which need to be paid enough attention in clinical practice.

关 键 词：急性脑梗死 重组组织型纤溶酶原激活剂溶栓 早期神经功能恶化 危险因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]