TCD持续监测颅内压对急性脑梗死溶栓后早期神经功能恶化的预测

Prediction of Early Neurological Deterioration after Thrombolysis in Acute Cerebral Infarction by Continuous TCD Monitoring of Intracranial Pressure

目的:分析经颅多普勒(Transcranial Doppler,TCD)持续监测颅内压(Intracranial pressure,ICP)对急性脑梗死溶栓后早期神经功能恶化(Early neurological deterioration,END)的预测价值。方法:回顾性分析我院2019年1月至2022年1月收治的109例接受溶栓治疗的急性脑梗死患者的临床资料,按照其END发生情况,将患者分别纳入END组、非END组,对比两组患者临床资料及治疗期间ICP变化差异,运用多因素logistic回归分析END的影响因素。结果:109例患者中,共有28例发生END,发生率为25.69%。END组26例(92.86%)患者TCD监测期间发生ICP升高,高于非END组的43.21%,差异有统计学意义(P<0.05)。Logistic多因素回归分析示,ICP升高、BMI≥28.0kg/m^(2)、基线NIHSS评分≥10分、大面积梗死均为影响急性脑梗死溶栓后END的独立危险因素(P<0.05)。结论:急性脑梗死溶栓后END发生率较高,且发生END者治疗期间普遍存在ICP上升,结合ICP上升、肥胖、基线高NIHSS评分、大面积梗死等因素有望为患者END的预测提供可靠参考。

Objective:To analyze the predictive value of continuous monitoring of intracranial pressure(ICP)by transcranial Doppler(TCD)for early neurological deterioration(END)after thrombolysis in acute cerebral infarction.Methods:The clinical data of 109 patients with acute cerebral infarction treated by thrombolytic therapy in our hospital from January 2019 to January 2022 were retrospectively analyzed.According to the occurrence of END,the patients were divided into END group and non-END group respectively.The clinical data of the two groups and the difference of ICP changes during treatment were compared,and the multivariate logistic regression was used to analyze the influencing factors of END.Results:Among the 109 patients,28 cases(25.69%)had END.26 cases(92.86%)in END group had ICP increase during TCD monitoring,which was higher than 43.21%in non-END group,and the difference was statistically significant(P<0.05).Logistic regression analysis showed that increased ICP,BMI≥28.0 kg/m^(2),baseline NIHSS score≥10,and large area infarction were all indepENDent risk factors for the end of acute cerebral infarction after thrombolysis(P<0.05).Conclusion:The incidence of END is high after thrombolysis in acute cerebral infarction,and the ICP is generally increased in patients with END during treatment.Combined with the factors of ICP increase,obesity,high NIHSS score at baseline,massive infarction and so on,it is expected to provide a reliable reference for the prediction of END in patients.