急性脑梗死患者时间窗内rt-PA溶栓治疗后脑水肿发生情况及其影响因素分析  

Analysis of the Occurrence and Influencing Factors of Cerebral Edema after Rt-PA Thrombolytic Therapy in Patients with Acute Cerebral Infarction Within the Time Window

作　　者：刘仰镇 LIU Yangzhen(Department of Neurology,Weishan County People’s Hospital,Jining 277600,China)

机构地区：[1]微山县人民医院神经内科,山东济宁277600

出　　处：《反射疗法与康复医学》2025年第5期97-100,共4页Reflexology And Rehabilitation Medicine

摘　　要：目的 探讨急性脑梗死(ACI)患者时间窗内阿替普酶(rt-PA)溶栓治疗后脑水肿发生情况及其影响因素。方法 回顾性分析2021年6月—2024年6月微山县人民医院收治的98例ACI患者的临床资料,所有患者均于溶栓后3 d复查颅脑CT或MRI,依据脑水肿发生情况分为脑水肿组与非脑水肿组。收集患者年龄、性别、吸烟史、饮酒史、合并糖尿病、合并高血压、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、脑梗死面积、溶栓前白细胞计数等多方面临床资料,开展Logistic回归分析,获得影响脑水肿发生的危险因素。结果 98例ACI患者中,发生脑水肿21例,脑水肿发生率为21.43%(21/98)。单因素分析显示,两组年龄、溶栓前NIHSS评分、脑梗死面积、溶栓前白细胞计数比较,组间差异有统计学意义(P<0.05);多因素Logistic回归分析显示,年龄≥65岁(OR=5.013,95%CI=1.663~15.117)、溶栓前NIHSS评分≥15分(OR=6.658,95%CI=2.043~-21.703)、脑梗死面积≥12.5 cm^(2)(OR=5.297,95%CI=1.754~15.990)、溶栓前白细胞计数≥10×10^(9)/L(OR=5.200,95%CI=1.801~15.011)为影响ACI患者rt-PA溶栓治疗后脑水肿发生的危险因素(P<0.05且OR>1)。结论 年龄≥65岁、溶栓前NIHSS评分≥15分、脑梗死面积≥12.5 cm^(2)、溶栓前白细胞计数≥10×10^(9)/L是ACI患者时间窗内rt-PA溶栓治疗后脑水肿发生的危险因素,还需于早期识别高风险群体,做好针对性防治措施。Objective To investigate the incidence and influencing factors of cerebral edema after thrombolytic therapy with alteplase(rt-PA)in patients with acute cerebral infarction(ACI)within the time window.Methods The clinical data of 98 patients with ACI admitted to Weishan County People’s Hospital from June 2021 to June 2024 were retrospectively analyzed.All patients underwent brain CT or MRI reexamination 3 days after thrombolysis.According to the occurrence of brain edema,they were divided into a brain edema group and a non-brain edema group.The patient’s age,gender,smoking history,drinking history,diabetes mellitus,hypertension,National Institutes of Health Stroke Scale(NIHSS)score before thrombolysis,cerebral infarction size,white blood cell count before thrombolysis and other clinical data were collected,and Logistic regression analysis was performed to obtain the risk factors affecting the occurrence of cerebral edema.Results Among 98 patients with ACI,21 cases had brain edema,and the incidence of brain edema was 21.43%(21/98).Univariate analysis showed that there were significant differences in age,NIHSS score before thrombolysis,cerebral infarction area,and white blood cell count before thrombolysis between the two groups(P<0.05).Multivariate Logistic regression analysis showed that age≥65 years old(OR=5.013,95%CI=1.663~15.117),NIHSS score≥15 before thrombolysis(OR=6.658,95%CI=2.043~21.703),cerebral infarction size≥12.5 cm^(2)(OR=5.297,95%CI=1.754~15.990),white blood cell count≥10×10^(9)/L before thrombolysis(OR=5.200,95%CI=1.801~15.011)were the risk factors for cerebral edema after rt-PA thrombolytic therapy in ACI patients(P<0.05 and OR>1).Conclusion Age≥65 years old,NIHSS score≥15 points before thrombolysis,cerebral infarction area≥12.5 cm^(2),white blood cell count≥10×10^(9)/L before thrombolysis are risk factors for cerebral edema after rt-PA thrombolysis in ACI patients within the time window.High-risk groups need to be identified early and targeted prevention and control measures.

关 键 词：急性脑梗死 阿替普酶溶栓 脑水肿 影响因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]