脑萎缩对严重缺血性脑卒中静脉溶栓治疗后早期神经功能恶化及预后的影响

Effect of cerebral atrophy on early neurological deterioration and prognosis after intravenous thrombolysis in severe ischemic stroke

目的探讨脑萎缩(BA)对静脉溶栓治疗严重缺血性脑卒中(ACI)早期神经功能恶化的影响。方法选择2017-01—2018-08解放军第985医院静脉溶栓治疗的严重ACI患者为研究对象,所有患者接受重组组织型纤溶酶原激活剂(rt-PA)溶栓治疗,以BV/CV作为相对脑容量,观察BV/CV与近期终点事件和预后的相关性。结果127例患者发生近期终点事件19例,发生率14.96%。终点事件和非终点事件患者年龄、糖尿病发生率差异有统计学意义(P<0.05),2组BV/CV水平比较差异无统计学意义(P>0.05)。127例患者3个月时mRS≤2分者51例,mRS>2分者76例,预后良好率为40.16%。mRS≤2分者和mRS>2分者年龄、基线血糖、高血压、糖尿病、近期终点事件差异有统计学意义(P<0.05),BV/CV差异无统计学意义(P>0.05)。结论BA与≥15分的严重ACI患者静脉溶栓的早期神经功能恶化和预后均无明显相关性。

Objective To explore the effect of cerebral atrophy(BA)on early neurological deterioration and prognosis of intravenous thrombolysis in severe ischemic stroke(ACI).Methods The patients with severe ACI who received intravenous thrombolysis in our hospital from January 2017 to August 2018 were selected as the research subjects.All patients received thrombolytic therapy with recombinant tissue plasminogen activator(rt-PA)to as the relative brain volume,BV/CV was used to observe the correlation between BV/CV and recent endpoint events and prognosis.Results Among the 127 patients,19 had a near-term endpoint event,and the incidence rate was 14.96%.There was a statistically significant difference in the age and incidence of diabetes between end-point events and non-end-point events(P<0.05).There was no statistically significant difference between the two groups in BV/CV levels(P>0.05).Among the 127 patients,51 patients had mRS scale≤2 points at 3 months and 76 patients>2 points.The good prognosis rate was 40.16%.There was a statistically significant difference in age,baseline blood glucose,hypertension,diabetes,and recent end-point events between the mRS scale≤2 points and>2 points(P<0.05),but there was no statistical difference in BV/CV(P<0.05).Conclusion There is no correlation between BA and early severe neurological function deterioration and prognosis of severe ACI patients with≥15 points.