急性脑梗死患者经重组组织型纤溶酶原激活物静脉溶栓治疗后预后的影响因素研究

Influencing Factors of Prognosis in Acute Cerebral Infarction Patients Treated by Intravenous Thrombolysis of rt-PA

目的探讨急性脑梗死患者经重组组织型纤溶酶原激活物(rt-PA)静脉溶栓治疗后预后的影响因素。方法选取2014年10月—2017年10月在无锡市锡山人民医院接受rt-PA静脉溶栓治疗的急性脑梗死患者110例,根据改良Rankin量表(mRS)评分分为预后良好组62例和预后不良组48例。比较两组患者性别、年龄、糖尿病病史、高血压病史、吸烟史、饮酒史、颅内动脉狭窄及心房颤动发生情况、入院时美国国立卫生研究院卒中量表(NIHSS)评分、发病至溶栓启动时间,急性脑梗死患者经rt-PA静脉溶栓治疗后预后的影响因素分析采用多因素Logistic回归分析。结果两组患者性别,有高血压病史、吸烟史、饮酒史者所占比例比较,差异无统计学意义(P>0.05);预后良好组患者年龄≥75岁者所占比例、有糖尿病病史者所占比例、入院时NIHSS评分、颅内动脉狭窄发生率、心房颤动发生率均低于预后不良组,发病至溶栓启动时间短于预后不良组(P<0.05)。多因素Logistic回归分析结果显示,年龄[OR=10.334,95%CI(2.831,37.719)]、糖尿病病史[OR=6.050,95%CI(1.615,22.177)]、心房颤动[OR=8.392,95%CI(1.661,42.385)]、入院时NIHSS评分[OR=6.781,95%CI(1.898,24.233)]、发病至溶栓启动时间[OR=9.137,95%CI(2.462,33.908)]是急性脑梗死患者经rt-PA静脉溶栓治疗后预后的影响因素(P<0.05)。结论高龄、糖尿病病史、入院时NIHSS评分高、心房颤动、发病至溶栓启动时间延长是急性脑梗死患者经rt-PA静脉溶栓治后预后不良的影响因素,应根据以上影响因素积极采取有效的干预措施以改善患者预后。

Objective To investigate the influencing factors of prognosis in acute cerebral infarction patients treated by intravenous thrombolysis of rt-PA.Methods A total of 110 acute cerebral infarction patients treated by intravenous thrombolysis of rt-PA were selected in Xishan People's Hospital of Wuxi from October 2014 to October 2017,and they were divided into A group(with good prognosis,n=62)and B group(with poor prognosis,n=48)according to the modified Rankin Scale score.Gender,age,history of diabetes,hypertension,smoking and drinking,incidence of intracranial arterial stenosis and atrial fibrillation,NIHSS score at admission,duration between attack and intravenous thrombolysis were compared the two groups,and multivariate Logistic regression analysis was used to analyze the influencing factors of prognosis in acute cerebral infarction patients treated by intravenous thrombolysis of rt-PA.Results No statistically significant differences of gender or proportion of patients with history of hypertension,smoking or drinking was found between the two groups(P>0.05);proportion of patients with age equal or over 75 years old,proportion of patients with diabetes history,incidence of intracranial arterial stenosis and atrial fibrillation,NIHSS score at admission in A group were statistically significantly lower than those in B group,and duration between attack and intravenous thrombolysis in A group was statistically significantly shorter than that in B group(P<0.05).Multivariate Logistic regression analysis results showed that,age〔OR=10.334,95%CI(2.831,37.719)〕,diabetes history〔OR=6.050,95%CI(1.615,22.177)〕,atrial fibrillation〔OR=8.392,95%CI(1.661,42.385)〕,NIHSS score at admission〔OR=6.781,95%CI(1.898,24.233)〕,duration between attack and intravenous thrombolysis〔OR=9.137,95%CI(2.462,33.908)〕were influencing factors of prognosis in acute cerebral infarction patients treated by intravenous thrombolysis of rt-PA(P<0.05).Conclusion Advanced age,diabetes history,high NIHSS score at admission,atrial fibrillation and extension of between attack and intravenous thrombolysis are influencing factors of poor prognosis in acute cerebral infarction patients treated by intravenous thrombolysis,so we should adopt active and effective intervention measures according above influencing factors to improve the prognosis.