老年后循环脑梗死患者静脉溶栓后近期预后影响因素分析

Influencing factors for the short-term prognosis in elderly patients with posterior circulation infarction after intravenous thrombolysis

目的探讨影响老年后循环脑梗死患者静脉溶栓后患者近期预后的因素。方法回顾性分析2011年3月至2013年12月后循环梗死并成功溶栓老年患者67例，收集包括年龄、性别、高血压、高血脂、糖代谢异常、发病至溶栓时间、入院时NIHSS评分、高同型半胱氨酸血症、梗死部位、抗凝和抗血小板治疗方式等资料。患者出院后进行跟踪随访，病后3个月复查时，采用改良Rankin量表（mRS）对患者预后进行评估，mRS评分≤2分为预后良好，mRS〉2分为预后不良，对预后良好组和预后不良组的例数进行统计分析。结果3个月复查时，预后良好43例（64．2％），预后不良24例（35．8％）。经过Logistic回归分析，与后循环脑梗死静脉溶栓后患者近期预后不良相关的因素有4项：入院时NIHSS评分〉12（95％CI：1．087～1．569，P=0．005）、发病至溶栓时间〉4．5h（95％CI：1．362～2．258，P=0．004）、高同型半胱氨酸血症（95％CI：0．612～0．956，P=0．000）、24h后抗血小板（95％CI：0．785～1．133，P=0．001）。结论对于后循环梗死老年患者，尽早溶栓且溶栓后及时进行抗凝治疗对改善近期预后有一定意义。

Objective To investigate the influencing factors for the short-term prognosis in elderly patients with posterior circulation infarction after intravenous thrombolysis. Methods We retrospectively analyzed the clinical data of 67 elderly patients with posterior circulation infarction treated with thrombolysis from March 2011 to December 2012. Clinical data of age, sex, hypertension, hyperlipidemia, glucose abnormalities, and thromholysis, National Institute of Health stroke scale （NIHSS） score on admission, hyperhomocystinemia, the infarction area, anticoagulation and antiplatelet treatment were collected. All patients were followed up after discharge. The prognosis was assessed by the Rankin scale （mRS） after 3 months of thrombolysis. Patients were divided into good （MRS score ≤2） prognosis group and poor （mRS〉2） prognosis group. Results There were 43 cases （64.20%） in good prognosis group and 24 cases （35.8%） in poor prognosis group. Logistic regression analysis showed that NIHSS score〉12 （95%CI： 1. 087-1. 569, P=0. 005）, thrombolysis time〉4.5 h （95%CI： 1. 362-2. 258, P=0. 004）, high homocysteine levels （95%CI： 0. 612-0. 956, P =0.000）, platelet after 24 h （95%CI： 0.785 1.133, P=0.001） were the independent risk factors for the poor prognosis of posterior circulation infarction in elderly patients after intravenous thrombolysis. Conclusions Early thrombolysis and timely anticoagulant treatments have certain significances in improving the short-term prognosis in patients with posterior circulation infarction.