脑梗死急诊溶栓患者的预后影响因素及其预测价值探讨

Prognostic Factors of Patients with Cerebral Infarction in Emergency Thrombolysis

目的:探索脑梗死急诊溶栓患者的预后因素及其预测价值。方法:分析2017年8月至2019年8月医院治疗的248例脑梗死急诊溶栓患者数据资料,按照患者神经恢复情况分为预后不良组(n=104)和预后良好组(n=144)。患者均接受静脉溶栓治疗。观察并分析可能影响脑梗死急诊溶栓患者预后的危险因素,进行多因素Logistic回归。并就部分因素/指标做关于预后的预测评估价值分析。结果:单因素分析结果显示:预后不良组发病-治疗时间、糖尿病既往病史发生率、同型半胱氨酸、血糖、静脉溶栓前收缩压与预后良好组相比差距比较明显(P<0.05);多因素回归结果显示:发病-治疗时间指标、NIHSS指标、糖尿病既往病史指标、同型半胱氨酸指标、血糖指标、静脉溶栓前收缩压指标是影响脑梗死急诊溶栓患者预后不良的显著影响因素(P<0.05)。其中3个指标(同型半胱氨酸、血糖、静脉溶栓前收缩压)经ROC分析,显示其对脑梗死急诊溶栓患者的预后有一定的预测评估价值,AUC(0.95CI)分别为:0.749(0.595~0.942)、0.783(0.666~0.921)、0.678(0.548~0.839)。联合应用对脑梗死急诊溶栓患者预后的预测评估价值更高,其AUC(0.95CI)为0.819(0.637~0.996)。结论:影响脑梗死急诊溶栓患者预后的独立危险因素较多,临床医师在诊治患者时需要密切关注发病-治疗时间、NIHSS、糖尿病既往病史、同型半胱氨酸、血糖、静脉溶栓前收缩压等因素。

Objective:To explore the prognostic factors and predictive value of thrombolytic patients with emergency cerebral infarction.Methods:The data of 248 patients with acute cerebral infarction treated by thrombolysis in hospital from August 2017 to August 2019 were analyzed and divided into poor prognosis group(n=104)and good prognosis group(n=144)according to the patients'neurological recovery.All patients received intravenous thrombolysis.The risk factors were observed and analyzed that may affect the prognosis of thrombolytic patients with emergency cerebral infarction,and perform multivariate logistic regression.And do some prognostic value analysis on the prognosis of some factors/indicators.Results:The results of univariate analysis showed that the onset-treatment time,incidence of diabetes history,homocysteine,blood glucose,and systolic blood pressure before intravenous thrombolysis in the poor prognosis group were significantly different from those in the good prognosis group(P<0.05);Multivariate regression results show that:onset-treatment time index,NIHSS index,previous diabetes history index,homocysteine index,blood glucose index,and systolic blood pressure index before intravenous thrombolysis are the significant factors affecting the poor prognosis of patients with acute cerebral infarction thrombolysis Influencing factors(P<0.05).Three of these indicators(homocysteine,blood glucose,and systolic blood pressure before intravenous thrombolysis)were analyzed by ROC,which showed that it had a certain predictive evaluation value for the prognosis of patients with acute cerebral infarction thrombolysis.The AUC(0.95CI)were:0.749(0.595~0.942),0.783(0.666~0.921),0.678(0.548-0.839).The combined application has a higher value in predicting the prognosis of patients with acute thrombolysis of cerebral infarction,and its AUC(0.95CI)is 0.819(0.637~0.996).Conclusion:There are many independent risk factors that influence the prognosis of patients with acute cerebral infarction thrombolysis.Clinicians need to pay close attention to the onset-treatment time,NIHSS,previous medical history of diabetes,homocysteine,blood glucose,systolic blood pressure before intravenous thrombolysis and other factors.