静脉溶栓治疗急性脑梗死患者预后相关因素分析

Prognostic factors of intravenous thrombolysis in patients with acute cerebral infarction

目的探讨静脉溶栓治疗急性脑梗死患者预后相关因素。方法选取长治市人民医院神经内科2016年1月-2018年3月收治的接受静脉溶栓治疗的急性脑梗死患者180例的临床资料。以预后时间为3个月后改良Rankin量表(mRS)的评分进行分组,其中0~2分91例设为预后良好组,≥3分89例设为预后不良组。对比2组患者的基本资料、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、溶栓前卒中分型、溶栓后脑出血因素及早期症状改善等因素。结果与预后良好组对比,预后不良组的溶栓前血糖、C反应蛋白(CRP)、溶栓前NIHSS评分≥9分、OCSP分型中完全前循环梗死、TOAST分型中大动脉硬化、心房颤动、溶栓后脑出血等发生率比较高,尿酸水平和溶栓后24 h神经功能改善比例明显降低(P均<0.05)。经多因素分析表明,溶栓前血糖、溶栓前NIHSS评分、OCSP分型、溶栓后24 h症状改善是预后独立影响因素(P均<0.05)。结论急性脑梗死患者静脉溶栓预后相关因素分析显示,患者的临床预后的独立影响因素为溶栓前血糖、溶栓前NIHSS评分、OCSP分型及溶栓后24 h症状改善等相关因素。

Objective To investigate the prognostic factors of intravenous thrombolysis in patients with acute cerebral infarction.Methods The clinical data of 180 patients with acute cerebral infarction who received intravenous thrombolytic therapy from January 2016 to March 2018 in the Department of Neurology Changzhi People’s Hospital were selected.The prognostic time was 3 months after the modified Rankin Scale(mRS)scores were used for grouping,with 0 to 2 points,91 cases were set as good prognosis group,and≥3 points,89 cases were set as poor prognosis group.The basic information of the two groups of patients,the National Institutes of Health Stroke Scale(NIHSS)score before thrombolysis,the type of stroke before thrombolysis,the factors of cerebral hemorrhage after thrombolysis and the improvement of early symptoms were compared.Results Compared with the good prognosis group,the pre-thrombotic blood glucose,C-reactive protein(CRP),pre-thrombin NIHSS score≥9 points,complete anterior circulation infarction in the OCSP classification,aortic sclerosis in the TOAST classification,atrial fibrillation,cerebral hemorrhage after thrombolysis incidence rate in poor prognosis group were relatively high,and uric acid level and the percentage of improvement in neural function 24 h after thrombolysis were significantly reduced(P<0.05).Multivariate analysis showed that pre-thrombotic blood glucose,pre-thrombotic NIHSS score,OCSP classification,and improvement of symptoms at 24 h after thrombolysis were independent prognostic factors(P<0.05).Conclusion Analysis of factors related to the prognosis of venous thrombolysis in patients with acute cerebral infarction showed that the independent influencing factors of clinical prognosis of patients were related factors such as blood glucose before thrombolysis,NIHSS score before thrombolysis,OCSP classification and improvement of symptoms at 24 h after thrombolysis.