急性脑梗死患者rt-PA静脉溶栓的临床疗效及相关影响因素分析

摘要

Objective:To observe the clinical efficacy and the related influence factors of intravenous thrombolytic therapy in 144 patients with acute cerebral infarction. Methods: Records of all patients admitted to our hospital with acute ischemic stroke and received the intravenous thrombolytic therapy from September 2010 to June 2014 were retrospectively reviewed. Collecting the general information and observed the trial of Org10172 in acute stroke treatment(TOAST) classification. The clinical efficacy were judged by analyzing asymptomatic survival , favorable outcome and unfavorable outcome. The related factors of asymptomatic survival, favorable outcome, intracranial hemorrhage and mortality were identified by the Logistic analysis. Results: Of these patients, the patients were divided into 5 groups according to the TOAST classification: large-artery atherosclerosis(n=50, 34.72%), cardioembolism(n=51, 35.42%), small-artery occlusion Lacunar(n=23, 15.97%), other determined etiology(n=2, 1.39%), and undetermined etiology(n=18, 12.50%). Asymptomatic survival was 60(41.67%), favorable outcome 82(56.94%), and unfavorable outcome was 62(43.06%). Logistic analysis showed that the onset to treat-ment time, baseline NIH stroke scale(NIHSS) score and early symptom improvement were the factors associated with favor-able outcome; the age, baseline NIHSS score and early symptom improvement were the factors associated with asymptomatic survival; atrial fibrillation, diastolic blood pressure and and older than 75 year-old were the factors associated with intracra-nial hemorrhage; the baseline NIHSS score was the factor associated with mortality. Conclusion: The clinical effect of intra-venous rt-PA thrombolytic therapy in patients with acute cerebral infarction in our hospital was good. Large-artery atheroscle-rosis and cardioembolism of cerebral infarction patients were more likely to benefit from the thrombolysis treatment.%目的：观察急性脑梗死患者静脉溶栓的临床疗效并分析相关的影响因素。方法：统计2010年9月—2014年6月接受重组人组织型纤溶酶原激活剂(recombinant human tissue type plasminogen activator，rt-PA)静脉溶栓治疗的急性脑梗死患者144例的一般资料，并分析所有溶栓患者的急性卒中治疗Org10172试验(trial of Org10172 in acute stroke treatment，TOAST)分型比例，通过统计无症状生存率、预后良好率和预后不良率来判断临床疗效。 Logistic多因素分析预后良好、无症状生存、颅内出血及死亡相关影响因素。结果：本组患者TOAST亚型的构成比例为：大动脉粥样硬化型50例(34.72%)，心原性脑栓塞型51例(35.42%)，小血管闭塞型23例(15.97%)，其他明确病因型2例(1.39%)，不明原因型18例(12.50%)。无症状生存60例(41.67%)，预后良好82例(56.94%)，预后不良62例(43.06%)。 Logistic分析结果显示：预后良好与给药时间、基线美国国际卫生部研究院卒中量表(NIH stroke scale，NIHSS)评分、溶栓后早期症状改善相关；无症状生存与年龄、基线NIHSS评分、早期症状改善相关；颅内出血与心房颤动病史、基线舒张压、年龄≥75岁相关；死亡与基线NIHSS评分相关。结论：我院急性脑梗死患者rt-PA静脉溶栓有较好疗效。其中大动脉粥样硬化型和心原性脑栓塞型的脑梗死患者更容易获得溶栓治疗。