急性缺血性脑卒中患者静脉溶栓治疗的临床预后及相关影响因素分析

Clinical prognosis and related factors of intravenous thrombolysis treatment in patients with ischemic stroke

目的探讨静脉溶栓治疗急性缺血性脑卒中(AIS)患者的近期和远期临床预后及相关影响因素。方法对187例在溶栓治疗窗内的AIS患者采用阿替普酶静脉溶栓治疗,溶栓后2周采用美国国立卫生研究院脑卒中量表(NIHSS)评分评估患者近期神经功能转归情况,溶栓后6个月采用改良Rankin量表(mRS)评估患者远期神经功能转归情况。采用多元logistic回归分析影响AIS近期及远期神经功能预后的因素。结果溶栓后2周140例(74.87%)患者神经功能好转,溶栓后6个月97例(51.87%)患者神经功能预后良好。溶栓后2周神经功能好转和未好转患者的收缩压、舒张压、肾小球滤过率(eGFR)、基线NIHSS评分、开始溶栓时间和梗死部位比较差异均有统计学意义(均P<0.01);溶栓后6个月时神经功能预后良好和非良好患者的收缩压、舒张压、eGFR、基线NIHSS评分、开始溶栓时间和梗死部位比较差异均有统计学意义(均P<0.01);多元logistic回归分析结果显示,收缩压、舒张压、基线NIHSS评分、开始溶栓时间和梗死部位均为影响静脉溶栓近期和远期临床预后的因素(均P<0.05)。结论静脉溶栓治疗可较好改善AIS患者近期及远期神经功能,而收缩压和舒张压升高、基线NIHSS评分、开始溶栓时间及脑梗死部位均是影响AIS患者近期及远期神经功能的因素。

Objective To investigate the short-term and long-termclinical prognosis of intravenous thrombolysis therapy in patients with acute ischemic stroke(AIS)and related factors.Methods One hundred and eighty-seven patients with AIS admitted in our hospital for intravenous thrombolysis treatment from January 2017 to December 2017 were included in the study.All patients were in the treatment window and received alteplase for thrombolysis therapy.National institutes of health stroke scale(NIHSS)was used to evaluate the short-term neurological outcome at 2nd week after thrombolysis.Modified rankin scale(mRS)was used to assess the long-term neurologic outcome at 6th month after thrombolysis.Multivariate logistic stepwise regression was used to analyze influencing factors for the short-term and long-term neurological outcomes of AIS.Results The neurological function of 187 patients was improved in 140(74.87%)patients at 2nd week after treatment,and 97(51.87%)patients at 6th month after thrombolysis treatment.There were statistically significant differences in systolic blood pressure,diastolic blood pressure,eGFR,baseline NIHSS score,the initial time of thrombolysis and infarct site between patients with and without improved neurological function both at 2nd week and at 6th month after intravenous thrombolysis(all P<0.05).Multivariate logistic regression analysis showed that systolic blood pressure,diastolic blood pressure,baseline NIHSS score,the initial time of thrombolysis and infarct site were independent influencing factors for short-term and long-term clinical prognosis of intravenous thrombolysis(all P<0.05).Conclusion Intravenous thrombolysis can significantly improve the short-term and long-term neurological function in patients with AIS,while the increase of systolic and diastolic blood pressure,baseline NIHSS score,the initial time of thrombolysis and infarct site are factors affecting the short-termand long-termprognosis in patients with AIS.