急性脑梗死患者rt-PA静脉溶栓后早期血氧参数与认知功能障碍的关系

Relationship between Early Blood Oxygen Parameters and Cognitive Dysfunction after Intravenous Thrombolysis with rt-PA in Patients with Acute Cerebral Infarction

目的:探究急性脑梗死患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后早期血氧参数与认知功能障碍的关系,为患者认知功能障碍防治措施提供循证依据。方法:回顾性分析2021年4月-2022年10月兰州大学第一医院115例开展rt-PA静脉溶栓治疗的急性脑梗死患者的临床资料。患者治疗后均获得3个月随访,依据简明精神状态检查量表(MMSE)评估患者认知功能障碍发生情况并分组(发生组、未发生组)。查阅、记录患者基线资料,统计患者静脉溶栓后第1天的血氧指标[氧减饱和度指数(ODI)、颈内静脉血氧饱和度(SjvO_(2))],重点分析静脉溶栓后第1天ODI、SjvO_(2)水平与急性脑梗死行静脉溶栓治疗患者认知功能障碍发生的关系。结果:调查结果显示,115例接受rt-PA静脉溶栓治疗的急性脑梗死患者中发生认知功能障碍48例,占比41.74%(48/115)。发生组溶栓后第1天ODI、SjvO_(2)水平均高于未发生组,差异均有统计学意义(P<0.001);发生组溶栓后第1天Dsv、Ssv水平均高于未发生组,差异均有统计学意义(P<0.001);组间其他基线资料比较,差异均无统计学意义(P>0.05)。经多因素logistic回归分析结果显示,溶栓后第1天ODI、SjvO_(2)、Dsv、Ssv水平高是急性脑梗死rt-PA静脉溶栓治疗后发生认知功能障碍的危险因素(P<0.05)。结论:急性脑梗死rt-PA静脉溶栓后第1天ODI、SjvO_(2)水平与患者溶栓治疗后并发认知功能障碍关系密切,二者水平异常升高会增加患者溶栓治疗后认知功能障碍发生风险。

Objective:To explore the relationship between early blood oxygen parameters and cognitive dysfunction after intravenous thrombolysis with recombinant tissue-type plasminogen activator(rt-PA)in patients with acute cerebral infarction,so as to provide evidence-based evidence for the prevention and treatment of cognitive dysfunction in patients.Method:The clinical data of 115 patients with acute cerebral infarction who underwent intravenous thrombolytic therapy with rt-PA in the First Hospital of Lanzhou University from April 2021 to October 2022 were retrospectively analyzed.All patients were followed up for 3 months after treatment.The incidence of cognitive dysfunction was evaluated according to the mini-mental state examination(MMSE)and the patients were divided into two groups(occurrence group and non occurrence group).The baseline data of patients were reviewed and recorded,and the blood oxygen indexes[oxygen desaturation index(ODI),internal jugular vein oxygen saturation(SjvO 2)]of the two groups on the first day after intravenous thrombolytic therapy were counted.The relationship between ODI,SjvO_(2) levels and cognitive dysfunction in patients with acute cerebral infarction treated with intravenous thrombolysis at the first day after intravenous thrombolysis was emphatically analyzed.Result:The results showed that 48 cases of cognitive dysfunction occurred in 115 patients with acute cerebral infarction who received intravenous thrombolytic therapy with rt-PA,accounting for 41.74%(48/115).The levels of ODI and SjvO_(2) in the occurrence group were higher than those in the non occurrence group on the first day after thrombolytic therapy,with statistical significant differences(P<0.001);the levels of D sv and S sv in the occurrence group were higher than those in the non occurrence group on the first day after thrombolysis,with statistical significant differences(P<0.001);there were no statistical significant differences in other baseline data between groups(P>0.05).Multivariate logistic regression analysis showed that the high levels of ODI,SjvO 2,D sv,S sv on the first day after thrombolytic therapy were risk factors for cognitive impairment after intravenous thrombolysi therapy with rt-PA for acute cerebral infarction(P<0.05).Conclusion:The ODI and SjvO_(2) levels at the first day after intravenous thrombolysis therapy with rt-PA for acute cerebral infarction are closely related to the cognitive dysfunction of patients after thrombolytic therapy,the abnormal increase of the two levels would increase the risk of cognitive dysfunction of patients after thrombolytic therapy.