急性缺血性脑卒中病人静脉溶栓治疗的临床预后影响因素分析

摘要

目的 探讨与分析急性缺血性脑卒中病人静脉溶栓治疗的价值与临床预后的影响因素.方法 采用回顾性研究方法,选取2013年9月—2016年2月在我院诊治的急性缺血性脑卒中病人120例,根据治疗方法的不同分为溶栓组与对照组,各60例.溶栓组静脉给予注射用重组人组织纤维蛋白溶酶原激活剂(rt-PA)治疗,对照组给予常规治疗.比较两组近远期疗效,采用多因素 Lo-gistic回归分析影响溶栓组预后的独立相关因素.结果 治疗后28 d,溶栓组总有效率为85.0%,高于对照组的68.3%,差异有统计学意义(P<0.05).治疗后90 d,溶栓组远期预后良好率为75.0%,高于对照组的56.7%,差异有统计学意义(P<0.05).溶栓组治疗后90 d的症状性脑出血与非症状性脑出血并发症发生率分别为0.0%、3.3%,对照组治疗后90 d的症状性脑出血与非症状性脑出血并发症发生率分别为6.7%、13.3%,溶栓组症状性脑出血与非症状性脑出血并发症发生率明显低于对照组(P<0.05).Logis-tic回归分析显示,年龄、入院时美国国立卫生研究院卒中量表(NIHSS)评分、糖尿病、发病到治疗时间为影响急性缺血性脑卒中病人静脉溶栓治疗的临床预后危险因素(P<0.05).结论 急性缺血性脑卒中病人采用 rt-PA静脉溶栓治疗具有很好的近远期疗效,也有很好的安全性,年龄、入院时 NIHSS评分、糖尿病、发病到治疗时间为影响溶栓治疗预后的危险因素.%Objective To explore the values of intravenous thrombolytic therapy in patients with acute ischemic stroke and the factors of the clinical prognosis.Methods One hundred and twenty patients with acute ischemic stroke in our hospital treated from September 2013 to February 2016 were selected and randomly divided into two groups:control group (n=60)treated with routine treatment,and treatment group(n=60)treated with intravenous injection of recombinant human tissue plasminogen fibrinolytic enzyme activator (rt-PA).The short-term and the long-term efficacy were observed.The risk factors were investigated by multivariate logistic re-gression analysis.Results After 30 days of treatment,the total short-term clinical effective rate after treatment was significantly higher in treatment group than that in control group(85.0% vs 68.3%,P<0.05).After 90 days of treatment,the long-term prognosis effective rate was significantly higher in treatment group than that in control group (75.0% vs 56.7%,P<0.05).The incidences of symptomatic cerebral hemorrhage and non symptomatic cerebral hemorrhage were 0.0%,3.3% in treatment group,and 6.7%,13.3% in control group,which was lower in treatment group than that in control group (P<0.05).Logistic regression analysis showed that age,National Institutes of Health Stroke Scale(NIHSS)score,diabetes mellitus,onset to treatment time were the prognostic risk fac-tors of intravenous thrombolysis in patients with acute ischemic stroke(P<0.05).Conclusion Acute ischemic stroke patients by in-travenous thrombolysis with rt-PA has good short-term and long-term efficacy.The age,admission NIHSS score,diabetes,onset to treatment time are the risk factors that affect the prognosis of thrombolytic therapy.