急性脑梗死患者静脉溶栓后早期神经功能改善的影响因素分析

Influencing factors of early neurological function improvement in patients with acute ischemic stroke after intravenous thrombolysis

目的分析急性缺血性脑卒中静脉溶栓患者发生早期神经功能改善的影响因素。方法采用连续入组方便取样的方法纳入2018年11月1日—2019年9月30日在北京市某三甲医院神经内科住院的所有满足纳入和排除标准的患者共353例,根据静脉溶栓后是否出现早期神经功能改善分为改善组和未改善组。分别对两组患者的基线临床特征、溶栓前后病情状况、溶栓后实验室指标、溶栓后血压等相关指标进行组间比较。将单因素分析中P<0.1的参数作为自变量,使用多因素Logistic回归分析进一步探究早期神经功能改善发生的独立影响因素。结果使用替罗非班(OR=0.305,95%CI=0.131~0.709,P=0.006)、静脉使用降压药物(OR=0.395,95%CI=0.175~0.894,P=0.026)、小脑梗死(OR=3.460,95%CI=1.314~9.106,P=0.012)、夜间收缩压最大值(OR=0.984,95%CI=0.969~0.998,P=0.026)是早期神经功能改善的独立影响因素。结论在使用溶栓药物后脑卒中症状不缓解或加重、梗死的部位以及夜间血压异常会影响早期神经功能改善的发生。

Objective To analyze the influencing factors of early neurological improvement in patients with acute ischemic stroke and intravenous thrombolysis.Methods A total of 353 patients who met the inclusion and exclusion criteria were included in the Department of Neurology of a third class hospital in Beijing from November 1,2018 to September 30,2019.They were divided into improved group and non improved group according to whether there was early neurological improvement after intravenous thrombolysis.The baseline clinical characteristics,condition before and after thrombolysis,laboratory indexes after thrombolysis and blood pressure after thrombolysis were compared between the two groups.The parameters with P<0.1 in univariate analysis were taken as independent variables,and multivariate logistic regression analysis was used to further explore the independent influencing factors of early neurological improvement.Results Use tirofiban(OR=0.305;95%CI=0.131,0.709;P=0.006),intravenous antihypertensive drugs(OR=0.395;95%CI=0.175,0.894;P=0.026),cerebellar infarction(OR=3.460;95%CI=1.314,9.106;P=0.012),nighttime systolic blood pressure(OR=0.984;95%CI=0.969,0.998;P=0.026)were independent influencing factors of early neurological improvement.Conclusion Stroke symptoms that are not relieved or worsened after the use of thrombolytic drugs,infarct sites and abnormal blood pressure at night can affect the incidence of neurological improvement.