急性缺血性卒中患者静脉溶栓效果的影响因素分析

摘要

Objective To observe and analyze the influence factors of clinical prognosis in patients with acute ischemic stroke (AIS)treated by intravenous thrombolysis.Methods One hundred patients with AIS treated by recom-binant tissue plasminogen activator (rt-PA)were selected.The patients were evaluated at 90d after attacked by modified Rankin Scale (mRS)score,and all cases were divided into good prognosis group (53 cases)and poor prognosis group (47 cases).The clinical data,safety of treatment and the mortality at 90d after attacked of two groups were observed and compared.Results After thrombolysis treatment,eight cases of intracranial hemorrhage were observed,five cases were symptomatic intracranial hemorrhage.Five patients died during 90d after attacked.There were statistically significant differences between the two groups on age,history of diabetes mellitus,NIHSS score before thrombolysis,time from attack to treatment,systolic pressure before thrombolysis and blood glucose before thrombolysis(t =4.727,5.126,2.715,4. 249,3.918,χ2 =7.868,P <0.05).Logistic multivariate regression analysis showed that the poor prognosis of AIS were as follow:history of diabetes mellitus (OR =1.567),NIHSS score before thrombolysis (OR =1.916),systolic blood pressure before thrombolysis (OR =1.269)and blood glucose before thrombolysis (OR =2.206)(P <0.05).Conclu-sions The short-term prognosis of patients with AIS after intravenous thrombolysis is related to a variety of factors.The clinicians should kown such high risk factors and effective intervene to improve the therapeutic effects and prognosis of patients.%目的：观察和分析急性缺血性卒中（AIS）患者静脉溶栓治疗的临床预后影响因素。方法选取100例行重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗的 AIS 患者作为研究对象，发病后90 d 行改良Rankin 量表（mRS）评价，并根据 mRS 评分将其分为预后良好组（53例）和预后不良组（47例），对两组患者的临床资料、治疗安全性及发病90 d 时的病死率进行观察和比较。结果溶栓治疗后，有8例患者发生颅内出血，其中，5例为症状性颅内出血；发病后90 d，共有5例患者死亡；预后良好组患者与预后不良组患者在年龄、糖尿病史、溶栓前 NIHSS 评分、起病至治疗时间、溶栓前收缩压、溶栓前血糖等方面的差异均有统计学意义（t ＝4．727、5．126、2．715、4．249、3．918，χ2＝7．868，P ＜0．05），Logistic 多元回归分析结果显示，患者溶栓治疗后出现不良预后与糖尿病史（OR ＝1．567）、溶栓前 NIHSS 评分（OR ＝1．916）、溶栓前收缩压（OR ＝1．269）、溶栓前血糖（OR ＝2．206）具有相关性（P ＜0．05）。结论AIS 患者静脉溶栓治疗后的近期预后与其神经功能损害程度、糖代谢异常、血压异常等因素有关，临床医生应对这些高危因素给予准确的识别和有效的干预，以达到提高治疗效果、改善患者预后的目的。