急性缺血性脑卒中患者静脉溶栓后早期神经功能恶化的研究

The analysis of early neurological deterioration after intravenous thrombolysis in patients with acute ischemic stroke

目的探讨急性脑梗死患者急性期内静脉溶栓后24 h内疗效及早期神经功能恶化(END)的发生率。方法收集急性脑梗死患者,比较溶栓组(n=118)和非溶栓组(n=51)患者的基线资料、评价指标(包括入院时NIHSS评分、入院后24 h NIHSS评分、入院24 h内早期神经功能恶化的发生率等)。结果 (1)非溶栓组24 h后NIHSS评分与入院时NIHSS评分无明显差异(Z=-0.086,P=0.932),溶栓组入院后24 h NIHSS评分小于入院时NIHSS评分(Z=-4.629,P=0.001);(2)溶栓组与非溶栓组比较,无论在END(χ~2=1.989,P=0.158)还是症状性出血(P=0.699)、脑梗死进展(P=0.176)、脑水肿(P=1.000)均没有明显差异。结论急性脑梗死静脉溶栓能有效改善早期脑梗死症状,同时不增加早期神经功能恶化的发生率。

Objective To evaluated the efficacy and early neurologic deterioration of patients with acute cerebral infarction in the 24 hours after intravenous thrombolysis. Methods Baseline date and evaluation pa- rameters, including N1HSS score on admission, NIHSS score in 24 hours after admission and the rate of early neurological deterioration were compared between intravenous thrombolysis group and non-thrombolysis group. Results 1） There was no statistically difference between NIHSS score in 24 hours after admission and NIHSS score on admission in non-thrombolysis group（Z = - 0. 086, P = 0. 932）. But there was statistically difference between N1HSS score in 24 hours after admission and NIHSS score on admission in thrombolysis group（Z= - 4. 629,P = 0. 001 ）, and NIHSS score in 24 hours after admission was less than NIHSS score on admission. 2） There was no statistically difference between intravenous thrombolysis group and non-thromhol- ysis group, either END or cerebral infarction hemorrhage transformation, progress of cerebral infarction, brain edema. Conclusion Intravenous thrombolysis could improve the early symptoms of cerebral infarction, with- out aggravating the earlv neurological deterioration.