急性缺血性脑卒中静脉溶栓预后的影响因素分析

Analysis of prognostic factors after intravenous thrombolysis in acute ischemic stroke

目的研究急性缺血性脑卒中静脉溶栓预后的影响因素。方法选择96例接受静脉溶栓治疗的急性缺血性脑卒中患者,观察年龄、性别、体质量、高血压史、糖尿病史、吸烟史、溶栓前收缩压、溶栓前血糖、起病-溶栓时间、溶栓前NIHSS评分等指标与预后的关系。结果预后不良组与预后良好组年龄、性别、体质量、高血压史、吸烟史无显著差异(P>0.05)。与预后良好组比较,预后不良组糖尿病史比例更高,溶栓前收缩压更高,溶栓前血糖更高,起病-溶栓时间更长,溶栓前NIHSS评分更高(P<0.05)。Logistic回归分析示,糖尿病史(OR=4,P=0.032)、溶栓前收缩压(OR=11,P=0.001)、溶栓前血糖(OR=10,P=0.028)、起病-溶栓时间(OR=1.01,P=0.013)、溶栓前NIHSS评分(OR=1.28,P=0.001)与溶栓预后不良显著相关。结论糖尿病史、溶栓前收缩压、溶栓前血糖、起病-溶栓时间、溶栓前NIHSS评分与预后不良密切相关,是预后不良的独立危险因素。

Objective To study the prognostic factors of intravenous thrombolytic therapy after acute ischemic stroke.Methods A total of 96 patients with acute ischemic stroke who underwent intravenous thrombolytic therapy from January 2015 to December 2016 in Guangdong province were enrolled in this study.The data of the patients were collected,such as the age,sex,weight,history of hypertension,history of diabetes mellitus,history of smoking,systolic pressure before thrombolysis,blood glucose before thrombolysis,onset-thrombolysis time,NIHSS score before thrombolysis and prognosis.Results There were no significant differences in age,sex,weight,history of hypertension,history of smoking and smoking between the two groups（P0.05）.Compared with the better prognosis group,the poor prognosis group showed higher proportion of diabetes,the systolic pressure before thrombolysis,the premenstrual blood glucose,onset-longer thrombolysis and higher NIHSS score before thrombolysis（P0.05）.The Logistic regression analysis showed that diabetes（OR=11,P=0.001）,thrombolytic blood glucose（OR=10,P=0.028）,onset-thrombolysis（OR=4,P=0.032）,thrombolysis（OR=1.01,P=0.013）,NIHSS score before thrombolysis（OR=1.28,P =0.001）was significantly associated with poor thrombolytic outcome.Conclusion The history of diabetes mellitus,systolic pressure before thrombolysis,blood glucose before thrombolysis,onset time-thrombolysis time,NIHSS score before thrombolysis are independent risk factors of poor prognosis in patients with acute ischemic stroke who underwent intravenous thrombolytic therapy.