急性脑卒中患者溶栓治疗后发生早期神经功能恶化的危险因素研究

摘要

Objective To evaluate the risk factors of early neurological deterioration (END) in patients with acute stroke after thrombolytic therapy for 24 h. Methods The clinical data of 678 patients with acute ischemic stroke who were hospitalized in ICU and received thrombolytic therapy were retrospectively analyzed. According to the occurrence of END patients after thrombolytic therapy 24 h, the patients were divided into END group and non-END group. The clinical data and prognosis of END group and non-END group were compared. The pathogenesis of END in patients was evaluated. Multivariate Logistic regression analysis was used to assess the factors associated with the occurrence of END in patients. Results Of the 678 patients, 142(20.9％ ) patients developed END at 24 h after thrombolysis. Univariate analysis showed that factors influencing the occurrence of END in the patients included: hypertension (χ2 =5.483,P =0.019),diabetes mellitus (χ2 =5.353,P=0.021),smoking(X2 =11.302,P ＜0.001), large-artery atherosclerosis (χ2 = 21.168, P ＜0.001),cardiogenic stroke(χ2 =28.129, P＜0.001) and admission NIHSS (z = 5.623,P=0.025). Large-artery atherosclerosis(OR=5.549,95％ CI = 1.124 ～2.388, P= 0.037), diabetes mellitus (OR=2.678, 95％ CI =1.258 ～5.539, P=0.015),hypertension (OR= 1.642, 95％ CI=l.178～2.263,P=0.005) were significantly associated with END in patients with acute stroke treated with thrombolytic therapy for 24 h. The pathogenesis of END included ischemic progression (42/142, 29.6％ ), recurrence of stroke(35/142, 24.6％ ),hemorrhagic transformation after infarction (33/142, 23.2％ ) and cerebral edema(32/142, 22.6％ ). Conclusion Ischemic progression and recurrence of stroke are the most important reasons after thrombolytic therapy in patients with END. Diabetes, hypertension, atherosclerosis, brain edema and hemorrhagic transformation are independent predictors of the occurrence of END after thrombolytic therapy within 24 h.%目的 评价急性脑卒中患者溶栓治疗24 h后,患者发生早期神经功能恶化(END)的危险因素.方法 收集在我院接受溶栓治疗的678例急性缺血性脑卒中患者的临床资料进行回顾性分析.根据患者溶栓治疗24 h后是否发生END,将患者分为END组与非END组,比较两组患者临床资料与预后,评价患者发生END的致病机制,采用多变量Logistic回归分析评价患者发生END的相关因素.结果 678例患者中有142(20.9％ )例患者在溶栓后24 h发生END.单因素分析显示,影响患者发生END的因素包括:高血压(x2 =5.483,P=0.019)、糖尿病(x2 =5.353,P = 0.021)、吸烟(X2=11.302,P＜0.001)、大动脉粥样硬化(X2 = 21.168,P ＜0.001)、心源性脑卒中(x2 =28.129,P＜0.001)和入院NIHSS评分(Z =5.623,P =0.025).END组患者预后明显变差.大动脉粥样硬化(OR =5.549,95％ CI =1.124 ～2.388,P =0.037)、糖尿病(OR = 2.678,95％ Cl = 1.258 ～5.539,P=0.015)、高血压(OR = 1.642,95％ CI = 1.178 ～ 2.263,P = 0.005)与急性脑卒中患者溶栓治疗24 h发生END显著相关.END的致病机制包括:缺血进展(42/142,29.6％ )、卒中复发(35/142,24.6％ )、梗死后出血转化(33/142,23.2％ )与脑水肿(32/142,22.6％ ).结论 缺血进展、卒中复发是溶栓治疗后患者发生END的重要原因,大动脉粥样硬化、糖尿病与高血压是溶栓治疗后24 h内发生END的独立预测因素.