静脉溶栓治疗的急性脑梗死患者早期症状反复波动的相关因素分析

Analysis of related factors of early repeated symptom fluctuations in patients with acute cerebral infarction treated by intravenous thrombolysis

目的探讨静脉溶栓的急性脑梗死患者溶栓24 h内症状反复波动的相关因素。方法收集在发病4.5 h内接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓的急性脑梗死患者101例,分为波动组与无波动组。收集两组患者的临床资料,并进行比较。结果波动组与无波动组患者的年龄、性别、溶栓前血压、溶栓前INR、发病-溶栓时间、低密度脂蛋白胆固醇(LDL-C)水平及高血压病、糖尿病史/糖化血红蛋白(HbA1c)>6%、吸烟史、TOAST分型、溶栓后24 h内颅内出血的比率差异均无统计学意义(均P>0.05)。波动组溶栓前NIHSS>3分及前循环梗死的比率显著高于无波动组(均P<0.05)。多因素Logistic回归分析显示,NIHSS>3分(OR=2.953,95%CI:1.044~8.354,P=0.041)和梗死部位(OR=4.020,95%CI:1.067~15.140,P=0.040)是症状波动的独立相关因素。结论静脉溶栓24 h内的症状反复波动与卒中严重程度及梗死部位相关。

Objective To analyze the related factors of repeated symptom fluctuations within 24 h after treated and related factors in patients with acute cerebral infarction undergoing intravenous thrombolysis. Methods One hundred and one patients with acute cerebral infarction who received recombinant tissue plasminogen activator(rt-PA) within 4.5 h of onset were divided into fluctuation group and non-fluctuation group. The clinical data were collected and compared between the two groups. Results There were no significant differences in age, gender, blood pressure before thrombolysis, INR before thrombolysis, onset-thrombolytic time, low-density lipoprotein cholesterol(LDL-C) and history of hypertension, history of diabetes/glycated hemoglobin(HbA1 c)>6%, history of smoking, TOAST classification and rate of intracranial bleeding within 24 h after thrombolysis between the two groups(all P>0.05). The proportions of NIHSS>3 before thrombolysis and anterior circulation infarction in the fluctuation group were significantly higher than those in the non-fluctuation group(all P<0.05). Multivariate Logistic regression analysis showed that NIHSS>3(OR=2.953, 95%CI: 1.044-8.354, P=0.041) and anterior circulation infarction(OR=4.020, 95%CI: 1.067-15.140, P=0.040) were independent factors associated with repeated symptom fluctuations. Conclusion Repeated fluctuations in symptoms within 24 h after intravenous thrombolysis are associated with stroke severity and infarct location.