急性脑梗死静脉溶栓治疗后近期预后不良的影响因素分析

Investigation analysis on risk factors of poor prognosis of acute cerebral infarct patients after treatment with venous thrombolysis

目的探讨急性脑梗死(ACI)患者静脉溶栓治疗的预后情况及其危险因素。方法对178例静脉溶栓治疗的ACI患者进行3个月的随访调查,依据预后情况将其分为预后良好组(102例)和预后不良组(76例);分析ACI患者溶栓后的近期预后不良发生率,筛选其预后不良的影响因素。结果 ACI患者静脉溶栓治疗后的预后不良率为42.70%(76/178);影响溶栓治疗后预后不良的危险因素包括高血压(OR=6.589)、溶栓时间窗(OR=3.162)、溶栓前NIHSS评分(OR=6.058)、溶栓前血糖(OR=3.452)及溶栓后脑出血(OR=4.039),而溶栓24 h后神经症状改善(OR=0.135)则为保护因素。结论 ACI患者通过静脉溶栓治疗后仍有较高的预后不良发生率,应针对以上高危因素,在溶栓时间窗内进行静脉溶栓治疗,采取必要的干预措施,改善ACI患者的预后。

Objective To explore the prognosis and its risk factors of acute cerebral infarct(ACI)patients after the treatment with venous thrombolysis.Methods Totally 178 ACI patients after treatment of venous thrombolysis were carried out a following-up survey within 3 months.These patients were divided into the good prognosis group(102 cases)and the poor prognosis group(76 cases)according to the evaluation of prognosis.The incidence rate of poor prognosis of ACI patients after venous thrombolysis treatment was described,and the risk factors of poor prognosis were screened.Results The incidence rate of poor prognosis of ACI patients after venous thrombolysis treatment was 42.70%(76/178).The risk factors of poor prognosis included hypertension(OR=6.589),thrombolysis time window(OR=3.162),NIHSS score before thrombolysis(OR=6.058),blood glucose before thrombolysis(OR=3.452)and cerebral hemorrhage after thrombolysis(OR=4.039),but improvement of neurological symptoms after 24 h of thrombolysis(OR=0.135)was the protective factors of poor prognosis.Conclusion ACI patients still have a high incidence rate of poor prognosis after venous thrombolysis.To aim directly at these above high risk factors,ACI patients should be carried out venous thrombolysis in the thrombolysis time window,and prevention measures should be early adopted,to improve prognosis of ACI patients.