缩短急性缺血性脑卒中患者入院至静脉溶栓时间对其疗效及预后的影响  

The Impact of Shortening the Door-to-Needle Time for Intravenous Thrombolysis on the Efficacy and Prognosis of Acute Ischemic Stroke Patients

作　　者：甄宏岳 欧俊灵 ZHEN Hongyue;OU Junling(Department of Neurology,Guangdong Central Hospital of Reclamation,Zhanjiang Guangdong 524000,China)

机构地区：[1]广东省农垦中心医院神经内科,广东湛江524000

出　　处：《中国卫生标准管理》2024年第19期76-79,共4页China Health Standard Management

摘　　要：目的探讨缩短急性缺血性脑卒中患者入院至静脉溶栓时间(door-to-needle time,DNT)对患者神经功能缺损评估、血液流变学及预后的影响。方法回顾性分析2021年1月—2022年12月广东省农垦中心医院收治的急性缺血性脑卒中患者143例为研究对象,根据患者不同DNT时间分组,其中DNT 0~59 min的61例为早期组,DNT≥60 min的82例为晚期组。比较2组治疗后急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)与美国国立卫生院卒中量表(NIH stroke scale,NIHSS)评分,治疗前、后血液流变学指标,治疗效果及随访90 d不良预后情况。结果治疗后6 h、24 h、7 d,早期组的APACHEⅡ评分为(33.95±4.52)分、(22.37±4.01)分、(12.15±2.73)分,NIHSS评分为(22.98±4.22)分、(16.47±2.61)分、(10.69±2.18)分,晚期组的APACHEⅡ评分为(37.43±5.37)分、(26.85±5.26)分、(17.06±2.96)分,NIHSS评分为(28.53±5.27)分、(20.05±3.46)分、(14.55±4.37)分,2组治疗后的APACHEⅡ、NIHSS评分均下降,且早期组低于晚期组,比较差异均有统计学意义(P<0.05);治疗后早期组的全血高切还原黏度(whole blood high shear reduction viscosity,HRV)、全血低切还原黏度(whole blood low shear reduced viscosity,LRV)、血浆黏度(plasma viscosity,PV)、纤维蛋白原(fibrinogen,Fib)水平分别为(3.06±0.81)mPa·s、(7.05±1.01)mPa·s、(1.07±0.21)mPa·s、(2.33±0.53)g/L,晚期组的HRV、LRV、PV、Fib水平为(4.21±1.04)mPa·s、(10.14±1.32)mPa·s、(1.53±0.32)mPa·s、(4.11±0.88)g/L,均低于治疗前,且早期组各项血液流变学指标水平均低于晚期组,比较差异均有统计学意义(P<0.05);早期组总有效率为96.72%,高于晚期组的86.59%,随访90 d脑出血、再发卒中发生率为0、1.64%,低于晚期组的7.32%、12.20%,差异有统计学意义(P<0.05)。2组患者死亡率比较差异无统计学意义(P>0.05)。结论缩短急性缺血性脑卒中患者的DNT可显著减轻患者病情及神经功能缺Objective To investigate the impact of shortening the door-to-needle time(DNT)for intravenous thrombolysis on neurological deficits,hemorheology,and prognosis in patients with acute ischemic stroke.Methods A retrospective analysis was conducted on 143 patients with acute ischemic stroke admitted to Guangdong Central Hospital of Reclamation from January 2021 to December 2022.Patients were grouped based on different DNT times for intravenous thrombolysis,with 61 cases in the early group(DNT with 0-59 minutes)and 82 cases in the late group(DNT≥60 minutes).A comparison was made between the two groups in terms of acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores,NIH stroke scale(NIHSS)scores after treatment,hemorheological indicators before and after treatment,and the evaluation of treatment effects and adverse outcomes at the 90-day follow-up.Results After 6 hours,24 hours,and 7 days of treatment,the APACHEⅡscores in the early group were(33.95±4.52)points,(22.37±4.01)points,(12.15±2.73)points,the NIHSS scores were(22.98±4.22)points,(16.47±2.61)points,(10.69±2.18)points,the APACHEⅡscores in the late group were(37.43±5.37)points,(26.85±5.26)points,(17.06±2.96)points,the NIHSS scores were(28.53±5.27)points,(20.05±3.46)points,(14.55±4.37)points.Compared to before treatment,both groups showed a decrease in APACHEⅡscores,NIHSS scores,and those in the early group were lower than those in the late group,and the differences were statistically significant(P<0.05).The levels of whole blood high shear reduction viscosity(HRV),whole blood low shear reduced viscosity(LRV),plasma viscosity(PV)and fibrinogen(Fib)in the early group after treatment were(3.06±0.81)mPa·s,(7.05±1.01)mPa·s,(1.07±0.21)mPa·s,(2.33±0.53)g/L.The levels of HRV,LRV,PV and Fib in the late group were(4.21±1.04)mPa·s,(10.14±1.32)mPa·s,(1.53±0.32)mPa·s and(4.11±0.88)g/L.The levels of hemorheological indexes in the early group were lower than those in the late group,and the differences were statistically significant

关 键 词：急性缺血性脑卒中 静脉溶栓 入院至静脉溶栓时间 神经功能缺损评分 血液流变学 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]