急性脑梗死患者阿替普酶静脉溶栓治疗预后不良因素分析

Analysis of the risk factors for poor prognosis of acute cerebral infarction patients treatment with rt-PA intravenous thrombolysis

目的探讨阿替普酶(rt-PA)静脉溶栓治疗超急性期脑梗死患者预后不良的危险因素。方法连续选取在我科住院接并受rt-PA静脉注射治疗的急性期脑梗死患者96例,记录患者一般资料、药物治疗情况、美国国立卫生研究院卒中量表(NHISS)基线评分、3个月改良Rankin量表(mRS)等功能评分,采用回顾性分析影响急性期脑梗死患者rt-PA静脉溶栓治疗预后的因素。结果预后良好组患者83例(86%)、预后不良组患者13例(14%);单因素分析提示:基线NIHSS评分>7、同侧责任大血管狭窄或闭塞、非全量rt-PA、肾功能不全、糖尿病等与静脉溶栓治疗预后不良相关(P <0.05),非条件多因素Logistic回归分析显示,溶栓前基线NIHSS评分>7[OR=19.27,95%CI (3.61,102.94),P=0.001)]、同侧责任大血管狭窄或闭塞[OR=10.29,95%CI(1.14,92.88),P=0.038]是导致rt-PA静脉溶栓后90d预后不良的独立危险因素。结论中-重度急性脑梗死及伴有责任大动脉狭窄或闭塞是rt-PA静脉溶栓后90d预后不良的独立危险因素。

Objective To observe the risk factors of poor prognosis of acute cerebral infarction patients treatment with rt-PA intravenous thrombolysis.Methods Ninty-six acute cerebral infarction patients accepted rt-PA intravenous thrombolysis treatment, patients＇ baseline information、 drug treatment、the baseline of United States National Institutes of Health Stroke Scale （NHISS） score、3 months Modified Rankin Scale （mRS） score were recorded, mRS score was analyzed for evaluating the prognosis function at the time of 3 months follow-up;prospectivel study method was used for analyzing the risk factors of prognosis of the patients with acute cerebral infarction .Results Eighty-three cases of patients with good prognosis group （86.5%）, 13 patients with poor prognosis group （13.5%）,univariate analysis revealed： the significant difference existed in baseline NIHSS score〉7、 ipsilateral large vascular stenosis or occlusion、the no-full dose of rt-PA、 renal insufficiency、 diabetes were associated with poor prognosis of intravenous thrombolysis treatment （ P 〈0.05）.Further multiariable logistic regression analysis revealed that the baseline NIHSS score〉7[ OR =19.27,95% CI （3.61,102.94）, P =0.001], ipsilateral large vascular stenosis or occlusion [ OR =10.29, 95% CI （1.14,92.88）, P =0.038] were the independent risk factors of 90 days poor prognosis after rt-PA intravenous thrombolysis.Conclusion Moderate or severe acute cerebral infarction and accompanied with ipsilateral large artery stenosis or occlusion were 90 days independent risk factors of poor prognosis of rt-PA intravenous thrombolysis.