应用阿替普酶溶栓疗法后影响心源性脑梗死患者预后的因素分析

Influence factors of survival status for patients with cardiogenic cerebral infarction after treatment of alteplase thrombolytic therapy

目的探索阿替普酶溶栓疗法对心源性脑梗死患者生存状况的影响。方法回顾性分析2016年7月至2018年7月于本院接受治疗的92例心源性脑梗死患者的临床资料,按照改良Rankin评价量表(mRS)评分将患者分为预后良好组和预后不良组。患者入院当天采用格拉斯哥昏迷量表(GCS)以及美国国立卫生研究院卒中量表(NIHSS)对患者神经功能情况进行评价,对患者进行CT平扫并评价患者出血情况。结果预后不良组>60岁患者占比明显高于预后良好组>60岁患者占比,预后良好组卵圆孔未闭发生率显著高于预后不良组,差异有统计学意义(P<0.05);两组患者性别、高血压、糖尿病、高脂血症、房颤、瓣膜心脏病、冠心病、心脏衰竭、扩张型心肌病、发病至静脉溶栓时间差异无统计学意义(P>0.05)。预后良好组基线NIHSS评分、基线GCS评分、溶栓前ASPECTS评分、症状性颅内出血与预后不良组对比,差异具有统计学意义(P<0.05);两组患者溶栓前高密度症状数据对比,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,年龄、基线NIHSS评分、症状性颅内出血是影响应用阿替普酶溶栓疗法后心源性脑梗死患者的独立危险因素(P<0.05)。结论阿替普酶溶栓治疗心源性脑梗死患者年龄越大、脑梗死程度越重或者出现症状性颅内出血,患者预后质量越差。

Objective To explore the influence factors of survival status for patients with cardiogenic cerebral infarction after treatment of alteplase thrombolytic therapy. Methods The clinical data of 92 patients with cardiogenic cerebral infarction who were treated in our hospital from July 2016 to July 2018 were retrospectively analyzed. Patients were classified into good prognosis group and poor prognosis group according to the modified Rankin Rating Scale(mRS) score. The patients were evaluated for neurological function using the Glasgow Coma Scale(GCS) and the National Institutes of Health Stroke Scale(NIHSS) on the day of admission. Patients underwent CT scans and assessed bleeding. Results The proportion of patients above 60 years old in the poor prognosis group was significantly higher than that of patients in good prognosis group. The incidence of patent foramen ovale in the good prognosis group was significantly higher than that in the poor prognosis group(P<0.05). There were no statistically significant differences in gender, hypertension, diabetes, hyperlipidemia, atrial fibrillation, valvular heart disease, coronary heart disease, heart failure, dilated cardiomyopathy, and onset-to-needle time between the two groups(P>0.05). Differences of baseline NIHSS score, baseline GCS score, pre-thrombosis ASPECTS score,symptomatic intracranial hemorrhage between the two groups were statistically significant(P<0.05). There was no statistically significant difference in density symptom data(P>0.05). Multivariate logistic regression analysis showed that age, baseline NIHSS score, and symptomatic intracranial hemorrhage were independent risk factors for patients with cardiogenic cerebral infarction after application of alteplase thrombolytic therapy(P<0.05). Conclusion Age, baseline NIHSS score, and symptomatic intracranial hemorrhage are independent risk factors for patients with cardiogenic cerebral infarction after application of alteplase thrombolytic therapy.