急性缺血性脑卒中溶栓患者二氧化碳结合力与短期预后的关系

Relationship between carbon dioxide combining power and the short-term prognosis in acute ischemic stroke patients after thrombolysis

目的探讨静脉血二氧化碳结合力(CO_(2)-CP)对急性缺血性脑卒中(AIS)患者溶栓治疗后短期预后的影响。方法回顾性分析2019年4月到2021年5月在中山大学孙逸仙纪念医院急诊科进行溶栓治疗的86例AIS住院患者的临床资料,根据就诊时的静脉血CO_(2)-CP水平将患者分为低CO_(2)-CP组(CO_(2)-CP<23 mmol/L,52例)和高CO_(2)-CP组(CO_(2)-CP≥23 mmol/L,34例),比较两组患者溶栓治疗前后CO_(2)-CP水平及其差值;采用美国国立卫生研究院卒中量表(NIHSS)评分评价患者溶栓治疗后的好转率〔(入院时NIHSS评分-出院时NIHSS评分)/入院时NIHSS评分)×100%〕和院内死亡情况;分析AIS患者急诊就诊时CO_(2)-CP与预后的相关性,绘制受试者工作特征曲线(ROC曲线)并计算ROC曲线下面积(AUC),评估CO_(2)-CP对溶栓患者预后的预测价值。结果低CO_(2)-CP组和高CO_(2)-CP组溶栓治疗后CO_(2)-CP均显著高于治疗前(mmol/L:23.08±2.34比20.46±1.51,25.24±2.16比23.94±1.07,均P<0.05),低CO_(2)-CP组治疗前后CO_(2)-CP差值明显高于高CO_(2)-CP组(mmol/L:2.62±0.83比1.30±1.09,P<0.05)。高CO_(2)-CP组好转率(NIHSS好转率>45%为好转)明显高于低CO_(2)-CP组〔85.29%(29/34)比23.08%(12/52)〕,而低CO_(2)-CP组病死率明显高于高CO_(2)-CP组〔11.54%(6/52)比0%(0/34),P<0.05〕;AIS溶栓患者急诊就诊时的CO_(2)-CP预测预后的AUC为0.820,95%可信区间(95%CI)为0.727~0.924,P=0.0001。结论AIS患者急诊就诊时如果CO_(2)-CP<23 mmol/L,提示其溶栓后的短期预后差,这对急诊卒中患者选择溶栓时机有一定的预测和临床参考作用。

Objective To investigate the effect of venous blood carbon dioxide binding capacity(CO_(2)-CP)on the short-term prognosis of patients with acute ischemic stroke(AIS)after thrombolytic therapy.Methods A total of 86 AIS inpatients who received thrombolytic therapy in the emergency department of Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from April 2019 to May 2021 were analyzed retrospectively.According to the venous blood CO_(2)-CP levels at admission,the patients were divided into two groups:low CO_(2)-CP group(CO_(2)-CP<23 mmol/L,n=52)and high CO_(2)-CP group(CO_(2)-CP≥23 mmol/L,n=34).The CO_(2)-CP levels and changes between the two groups before and after thrombolytic therapy were compared.The National Institutes of Health Stroke scale(NIHSS)score was used to evaluate the improvement rate of patients after thrombolytic therapy[NIHSS score at admission-NIHSS score at discharge)/NIHSS score at admission×100%]and in-hospital death was also recorded.The correlation between CO_(2)-CP levels and prognosis of patients with AIS during emergency visit was analyzed,the receiver operator characteristic curve(ROC curve)was drawn and the area under the ROC curve(AUC)was calculated to evaluate the predictive value of CO_(2)-CP in the prognosis of AIS patients.Results The CO_(2)-CP levels of low CO_(2)-CP group and high CO_(2)-CP group after thrombolytic therapy were significantly higher than those before treatment(mmol/L:23.08±2.34 vs.20.46±1.51,25.24±2.16 vs.23.94±1.07,both P<0.05).The differences of CO_(2)-CP before and after treatment in low CO_(2)-CP group were significantly higher than those in high CO_(2)-CP group(mmol/L:2.62±0.83 vs.1.30±1.09,P<0.05).The improvement rate of CO_(2)-CP levels in the high CO_(2)-CP group(NIHSS improvement rate>45%)was significantly higher than that in the low CO_(2)-CP group[85.29%(29/34)vs.23.08%(12/52)],while the mortality in the low CO_(2)-CP group was significantly higher than that in the high CO_(2)-CP group[11.54%(6/52)vs.0%(0/34),P<0.05].The AUC of CO_(2)-CP for the prognosis of patients with AIS thrombolysis was 0.820,the 95%confidence interval(95%CI)was 0.727-0.924,P=0.0001.Conclusion AIS patients with CO_(2)-CP levels less than 23 mmol/L have a poor short-term prognosis,which has certain predictive and clinical reference value for choosing thrombolytic time in emergency stroke patients.