老年急性脑梗死患者静脉溶栓治疗临床预后的影响因素分析

摘要

Objective To study the influencing factors of clinical outcome in elderly acute ischemic stroke (AIS) patients after intravenous thrombolysis.Methods One hundred and fifty-one AIS patients admitted to our hospital for intravenous thrombolysis were divided into good outcome group (n=77) and poor outcome group (n=74) according to their modified Rankin scale score 3 months after the onset of AIS.The baseline data,thrombolysis time window,NIHSS score and ischemic stroke typing before thrombolysis,early symptom improvement,cerebral hemorrhage after thrombolysis were compared between the two groups.Results The serum levels of blood glucose and CRP,NIHSS score≥9 before thrombolysis,incidence of AF and cerebral hemorrhage were significantly higher in poor outcome group than in good outcome group (P＜ 0.05,P＜0.01).Multivariate logistic regression analysis showed that NIHSS score,OCSP typing,blood glucose before thrombolysis,24 h symptom improvement were the independent influencing factors of clinical outcome in elderly AIS patients (OR =1.262,95 ％ CI:1.075-1.482,P =0.005;OR =0.203,95％CI:0.066-0.628,P=0.006;OR=1.264,95％CI:1.042-1.532,P=0.017;OR=25.764,95％CI:5.131-129.361,P=0.000).Conclusion NIHSS score,OCSP typing,blood glucose before thrombolysis and 24 h symptom improvement are the independent influencing factors of clinical outcome in elderly AIS patients after intravenous thrombolysis.%目的 探讨老年急性脑梗死患者静脉溶栓治疗临床预后的影响因素.方法 回顾性分析我院所有接受静脉溶栓治疗的急性老年脑梗死患者151例,预后终点为发病3个月后改良的Rankin量表评分,其中0～2分(预后良好组)77例,≥3分(预后不良组)74例.比较2组患者的基线临床资料、溶栓时间窗、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、溶栓前脑卒中分型、早期症状改善、溶栓后脑出血等因素.结果 预后不良组患者溶栓前血糖、C反应蛋白、溶栓前NIHSS评分≥9分、心房颤动、溶栓后脑出血等显著高于预后良好组(P＜0.05,P＜0.01).多因素logistic回归分析显示:溶栓前NIHSS评分(OR=1.262,95％CI:1.075～1.482,P=0.005)、OCSP(牛津郡社区卒中项目)分型(OR=0.203,95％CI:0.066～0.628,P=0.006)、溶栓前血糖(OR=1.264,95％CI:1.042～1.532,P=0.017)、溶栓后24 h症状改善(OR=25.764,95％CI:5.131～129.361,P=0.000)是患者预后的独立影响因素.结论 老年急性脑梗死患者行静脉溶栓治疗的预后受多种因素影响,溶栓前NIHSS评分、OCSP分型、溶栓前血糖及溶栓后24 h症状改善等因素是患者临床预后的独立影响因素.