急性缺血性脑卒中患者静脉溶栓后早期神经功能恶化的影响因素及G-FAST评分的预测价值

Influence factors of the early deterioration of neurological function after intravenous thrombolysis and the predictive value of G-FAST score in patients with acute ischemic stroke

目的探讨急性缺血性脑卒中(AIS)患者阿替普酶静脉溶栓后早期神经功能恶化(END)的影响因素及凝视-面-臂-言语-时间(G-FAST)评分的预测价值。方法回顾性分析2016年1月至2019年1月沈阳医学院附属第二医院收治并采用阿替普酶静脉溶栓治疗的219例AIS患者。用美国国立卫生研究院卒中量表(NIHSS)评估静脉溶栓治疗后END的发生情况。Logistic回归分析影响END的因素;受试者工作特征(ROC)曲线分析各指标预测END的价值。结果219例患者中43例患者发生END,占19.63%。年龄≥60岁(OR=1.035,95%CI:1.003~1.236)、心房颤动病史(OR=1.925,95%CI:1.313~2.685)、昏迷(OR=2.031,95%CI:1.340~3.026)、入院时NIHSS评分≥10分(OR=1.368,95%CI:1.167~2.361)及入院时G-FAST评分≥3分(OR=1.509,95%CI:1.368~3.165)是END发生的独立危险因素(P<0.05)。G-FAST评分和NIHSS评分及二者联合预测END的ROC曲线下面积分别为0.768、0.733和0.897。结论阿替普酶静脉溶栓后END发生的影响因素较多,G-FAST量表对END有一定预测价值。

Objective To explore the influence factors of early neurological deterioration(END)after intravenous thrombolysis with alteplase and the predictive value of gaze face arm speech time(G-FAST)score in patients with acute ischemic stroke(AIS).Methods A total of 219 patients with AIS treated with alteplase for intravenous thrombolysis in the Second Affiliated Hospital of Shenyang Medical College from January 2016 to January 2019 were retrospectively analyzed.The National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the incidence of END after intravenous thrombolysis with alteplase.Logistic regression was used to analyze the influencing factors of END,and receiver operating characteristic(ROC)curve was used to analyze the value of each indicator to predict END.Results Among the 219 patients,43 patients had END,accounting for 19.63%.Age≥60(OR=1.035,95%CI:1.003-1.236),history of atrial fibrillation(OR=1.925,95%CI:1.313-2.685),coma(OR=2.031,95%CI:1.340-3.026),NIHSS score≥10(OR=1.368,95%CI:1.167-2.361)and G-FAST score≥3(OR=1.509,95%CI:1.368-3.165)were independent risk factors for END(P<0.05).G-FAST score,NIHSS score and the area under ROC curve combined predicted by them were 0.768,0.733 and 0.897,respectively.Conclusions There are many factors influencing the occurrence of END after intravenous thrombolysis with alteplase.G-FAST scale has certain predictive value for END.