急性脑梗死患者静脉溶栓治疗后脑疝形成的因素探讨  

Exploring the factors leading to brain herniation in patients with acute cerebral infarction after intravenous thrombolysis therapy

作　　者：王洪超 王越 李金萍 WANG Hongchao;WANG Yue;LI Jinping(Department of Neurology,People's Hospital of Langfang City,Langfang 065000,China)

机构地区：[1]廊坊市人民医院神经内科,065000 [2]廊坊市人民医院急诊科,065000 [3]廊坊市第四人民医院肿瘤科

出　　处：《临床神经病学杂志》2024年第6期401-405,共5页Journal of Clinical Neurology

摘　　要：目的 基于倾向性评分匹配法(PSM)探讨急性脑梗死患者静脉溶栓治疗后脑疝形成的危险因素。方法 回顾性选取2019年1月至2023年5月在本院行静脉溶栓治疗的443例急性脑梗死患者,根据静脉溶栓治疗后有无脑疝形成将其分为脑疝组和非脑疝组,采用PSM法均衡两组基线期资料,并采用单因素和多因素Logistic回归分析法分析PSM后急性脑梗死患者静脉溶栓治疗后脑疝形成的危险因素。结果 经PSM后,脑疝组和非脑疝组共成功匹配57对患者,两组性别、年龄、吸烟史、饮酒史差异均无统计学意义(均P>0.05)。单因素分析结果显示,脑疝组和非脑疝组合并心房颤动、TOAST分型、梗死部位、大面积脑梗死、NIHSS评分、血小板计数、中性粒细胞计数/淋巴细胞计数(NLR)、D-二聚体、C反应蛋白、血管成功再通、侧支循环不良的比较,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,TOAST分型心源性栓塞型、前循环梗死、大面积脑梗死、侧支循环不良、NIHSS评分较高、NLR较高均是急性脑梗死患者静脉溶栓治疗后脑疝形成的独立危险因素(均P<0.05)。结论 经PSM法均衡性别、年龄、吸烟史、饮酒史后,TOAST分型心源性栓塞型、前循环梗死、大面积脑梗死、侧支循环不良、NIHSS评分较高、NLR较高均是急性脑梗死患者静脉溶栓治疗后脑疝形成的独立危险因素。Objective To explore the risk factors of brain herniation in patients with acute cerebral infarction after intravenous thrombolysis therapy based on propensity score matching(PSM)method.Methods A retrospective selection was conducted on 443 patients with acute cerebral infarction who underwent intravenous thrombolysis treatment in our hospital from January 2019 to May 2023.They were divided into brain herniation group and non brain herniation group based on the presence or absence of brain herniation after intravenous thrombolysis treatment.The baseline data of the two groups were balanced using PSM method,and the risk factors for cerebral hernia formation after intravenous thrombolysis treatment in patients with acute cerebral infarction after PSM were analyzed using univariate and multivariate Logistic regression analysis.Results After PSM,a total of 57 pairs of patients were successfully matched between the brain herniation group and the non brain herniation group.There was no statistically significant difference in gender,age,smoking history,and drinking history between the two groups(all P>0.05).The results of univariate analysis showed that there were statistically significant differences between the brain herniation group and the non brain herniation group with atrial fibrillation,TOAST typing,infarction site,massive cerebral infarction,NIHSS score,platelet count,neutrophil count/lymphocyte count(NLR),D-dimer,C-reactive protein,successful recanalization of blood vessels,and poor collateral circulation(all P<0.05).The results of multivariate Logistic regression analysis showed that TOAST classification was cardiogenic embolism type,anterior circulation infarction,massive cerebral infarction,poor collateral circulation,high NIHSS score,and high NLR were all independent risk factors for brain herniation in patients with acute cerebral infarction after intravenous thrombolysis treatment(all P<0.05).Conclusion After balancing gender,age,smoking history and drinking history using PSM,cardiogenic embolism type in

关 键 词：急性脑梗死 静脉溶栓 脑疝 影响因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]