静脉溶栓对小卒中患者90天功能预后的影响

Influence of 90d function outcomes in patients with minor stroke accepted intravenous thrombolysis treatment

目的探讨rt-PA静脉溶栓对小卒中患者90天功能预后的影响。方法连续选取在我科住院的美国国立卫生研究院卒中量表(NIHSS)评分为0~3分的超早期脑梗死患者66例,所有患者起病至入院时间均为4.5h以内,其中接受rt-PA静脉溶栓患者35例,接受一般药物治疗患者31例。记录患者一般资料、既往史、化验指标、影像学结果、基线NIHSS评分、3个月改良Rankin量表(mRs)评分。将3个月时mRs作为患者功能预后的判定指标,比较两组患者90天时的功能预后。结果两组患者的年龄、性别、高血压病、冠心病、脑梗死、糖尿病、心房纤颤、脑出血、吸烟、饮酒等差异无统计学意义(P>0.05);化验指标及影像学检查提示:高同型半胱氨酸血症(hHCY)、尿蛋白阳性、幕上脑梗死患者的比例,以及尿酸、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、甘油三酯(TG)、β微球蛋白(β-MG)在两组间无统计学差异(P>0.05)。观察组基线NIHSS评分中位数为3,对照组基线NIHSS评分中位数为2,经过秩和检验,两组间无统计学差异(P>0.05)。两组90天mRs评分中位数均为0,无统计学差异,但观察组mRs为0分患者比例较高,对照组mRs为1分患者比例较高,观察组无mRs≥3分患者。结论尽管静脉溶栓并不增加90天时患者整体功能,但小卒中患者接受rt-PA静脉溶栓后增加完全无功能障碍患者的比例,一定程度上减少了轻-中度功能残疾的发生。

Objective To observe the influence of 90d function outcomes in patients with minor stroke accepted intravenous thrombolysis treatment. Methods 66 cases of acute minor stroke patients with low National Institutes of Health Stroke Scale （NIHSS） scores 0~3 were enrolled in this study, all cerebral infarction onset within 4.5 hours, 35 patients accepted rt-PA intravenous thrombolysis treatment in observation group and 31 cases accepted conventional treatments in control group. The clinical data of all patients were collected including common data,past medical history,laboratory information,radiographic results,baseline NIHSS and modified Rankin score （mRs）of 90d, mRs of 90d was defined as function outcomes evaluation criteria. Prospectivel study method was used to compare 90d outcomes between the two groups. Results There was no statistically significant difference between the two groups in baseline data about age,gender,history of hypertension,coronary heart disease, cerebral infarction and cerebral hemorrhage,diabetes mellitus, atrial fibrillation,smoking,drinking （P 〉0.05）. There was no statistically significant difference between the two groups in the proportion of hyperhomocysteinemia （hHCY）, proteinuria,supratentorial infarction,and uric acid （UA）,total cholesterols （TC）, triglycerides （TG）, high density lipoprotein （HDL）, low density lipoprotein （LDL）, beta-microglobulin （β-MG）, P 〉0.05. The median of baseline NIHSS in the observation group and the control group was 3 and 2 respectively. Rank sum test showed that there was no statistically significant difference between the two groups （P 〉0.05）. The median mRs of 90d in the two groups both were 0, there was no statistically significant difference, but the proportion of mRs=0 patients was higher in the observation group, the proportion of mRs=1 patients was higher in the control group and the observation group had no poor outcome patients with mRs≥3. Conclusion Although intravenous thrombolysis don＇t improve the overall outcome of 90d, but the proportion of patients without dysfunction in minor stroke patients receiving rt-PA intravenous thrombolysis increases, to a certain degree, the proportion of mild-to-moderate disability reduce.