急性缺血性脑卒中合并房颤患者的危险因素和静脉溶栓疗效分析

Analysis of Risk Factors and Intravenous Thrombolytic Effect in Patients with Acute Ischemic Stroke Complicated with Atrial Fibrillation

目的探讨急性缺血性脑卒中合并房颤患者的危险因素以及采取阿替普酶静脉溶栓的临床疗效。方法选取该院2017年3月—2019年3月采取rt-PA静脉溶栓治疗的急性脑梗死病例共123例,根据是否合并心房颤动分为房颤组(48例)和非房颤组(75例)。分析两组患者的危险因素以及阿替普酶静脉溶栓过程中美国国立卫生研究院卒中量表(NIHSS)评分的变化。结果Logistic多因素回归分析发现年龄、既往糖尿病、房颤、脑血管病史属于严重急性缺血性脑卒中的独立危险因素(P=0.005、0.022、0.003、0.004)。房颤组在溶栓前、溶栓结束时、溶栓24 h的NIHSS评分为(15.81±6.52)分、(10.41±6.12)分、(8.90±5.72)分,非房颤组为(11.92±8.40)分、(5.93±5.29)分、(4.62±4.79)分;房颤组和非房颤组在组内各时间段NIHSS评分比较均差异有统计学意义(P<0.05);同一时间段,房颤组和非房颤组NIHSS评分比较均差异有统计学意义(P<0.05)。房颤组、非房颤组在颅内出血转化上,二者比较差异有统计学意义(χ2=11.234,P=0.002);非房颤组、房颤组在症状性颅内出血转化及不良结局上两组比较均差异无统计学意义(χ2=2.920、1.895,P=0.127、0.073)。多因素回归分析发现,房颤和高NIHSS评分为溶栓后出血的独立危险因素(P=0.009、0.008)。结论房颤是中度至重度急性缺血性脑卒中的独立危险因素,采用阿替普酶对脑梗死合并有房颤患者进行静脉溶栓时要在充分评估患者病情与NIHSS评分下进行。

Objective To investigate the risk factors of patients with acute ischemic stroke complicated with atrial fibrillation and the clinical efficacy of intravenous thrombolytic therapy with alteplase.Methods A total of 123 patients with acute cerebral infarction who underwent rt-PA intravenous thrombolysis from March 2017 to March 2019 were enrolled.The patients were divided into atrial fibrillation group(48 cases)and non-atrial fibrillation group(75 cases)according to whether or not they had atrial fibrillation.Risk factors for the two groups of patients and changes in the National Institutes of Health Stroke Scale(NIHSS)score during the intravenous thrombolysis of alteplase were analyzed.Results Logistic multivariate regression analysis found that age,previous diabetes,atrial fibrillation,and cerebrovascular disease were independent risk factors for severe acute ischemic stroke(P=0.005,0.022,0.003,0.004).The NIHSS scores of the atrial fibrillation group before thrombolysis,at the end of thrombolysis,and at 24 h after thrombolysis were(15.81±6.52)points,(10.41±6.12)points,(8.90±5.72)points,and non-atrial fibrillation group(11.92±8.40)points,(5.93±5.29)points,(4.62±4.79)points;the differences of NIHSS scores in the atrial fibrillation group and non-atrial fibrillation group were statistically significant(P<0.05);There were statistically significant differences in NIHSS scores in the same time period of the atrial fibrillation group and non-atrial fibrillation group(P<0.05).There was a statistically significant difference between the atrial fibrillation group and the non-atrial fibrillation group in the conversion of intracranial hemorrhage(χ2=11.234,P=0.002).The non-atrial fibrillation group and the atrial fibrillation group were involved in the conversion of symptomatic intracranial hemorrhage and adverse outcomes.There was no statistically significant difference between the two groups(χ2=2.920,1.895,P=0.127,0.073).Multivariate regression analysis found that atrial fibrillation and high NIHSS scores were independent risk factors for hemorrhage after thrombolysis(P=0.009,0.008).Conclusion Atrial fibrillation is an independent risk factor for moderate to severe acute ischemic stroke.Alteplase should be used to fully evaluate patients'condition and NIHSS score when performing intravenous thrombolysis in patients with cerebral infarction and atrial fibrillation.