急性脑梗死患者行尿激酶静脉溶栓治疗时早期神经功能恶化的危险因素分析

Analysis of risk Factors for Early Neurological Deterioration in Patients with Acute Cerebral Infarction Treated with intravenous Thrombolysis Therapy by Urokinase

目的探究急性脑梗死行尿激酶静脉溶栓治疗患者早期神经功能恶化的危险因素,为临床精准化溶栓治疗提供依据。方法选择2010年1月~2016年12月在本院神经内科连续登记发病4.5 h内给予尿激酶静脉溶栓治疗的急性脑梗死患者作为研究对象。将进行静脉溶栓治疗且资料完整的患者共180例患者根据溶栓后是否发生早期神经功能恶化分为恶化组以及非恶化组。恶化组包括患者31例,非恶化组包括患者149例。比较两组患者的基线资料,并分析溶栓治疗患者早期神经功能恶化的危险因素。结果结果表明,恶化组患者的随机血糖、白细胞计数、肌酐、吞咽障碍、责任大血管狭窄程度等指标均显著高于非恶化组,差异均具有统计学意义(P<0.05),而其它基线资料比较差异无统计学意义(P>0.05)。年龄、血糖、白细胞计数、NIHSS评分、吞咽障碍、昏迷、责任大血管闭塞、心源性脑栓塞等均与患者溶栓后早期神经功能恶化显著相关(P<0.05)。结论对于急性脑梗死患者在采取静脉溶栓治疗前,应尽快完善易引发早期神经功能恶化相关危险因素的检查,根据患者实际情况选择安全有效的治疗方法,提高患者的治愈率及生存率。

Objective To investigate the risk factors of early neurological deterioration in patients with acute cerebral infarction treated with intravenous thrombolysis therapy by urokinase, and to provide the basis for clinical accurate thrombolytic therapy. Methods From January 2010 to December 2016, patients with acute cerebral infarction who were treated with intravenous thrombolysis therapy by urokinase within 4. 5 h in our hospital were enrolled in this study. A total of 180 patients undergoing intravenous thrombolytic therapy with complete data were divided into deterioration group and non deteriorating group according to the early neurological deterioration after thrombolysis. The deterioration group included 31 patients, and the non deteriorating group included patients with a total of 149 patients. The baseline data of two groups were compared, and the risk factors of early neurological deterioration were analyzed. Results The results showed that the deterioration of patients with random blood glucose, white blood cell count, serum creatinine, dysphagia, responsibility vascular stenosis degree were significantly higher than those of non deterioration group, the differences were statistically significant （ P 〈 0. 05 ）, and other baseline data were not statistically significant（ P 〉 0. 05 ）. Age, blood glucose, white blood cell count, NIHSS score, dysphagia, coma, major vascular occlusion, and cardiogenie cerebral embolism were significantly correlated with early neurological deterioration after thrombolysis （ P 〈 0. 05 ）. Conclusion For patients with acute cerebral infarction after taking intravenous thrombolytic therapy before, should be improved as soon as possible causes of early neurological deterioration in risk factors related to the examination, according to the choice of safe and effective therapy for patients with the actual situation, improve the cure rate and survival rate of patients.