静脉溶栓治疗不同卒中类型老年缺血性脑卒中的疗效

Efficacy of intravenous thrombolysis in the treatment of ischemic stroke in elderly patients with different stroke types

目的探讨不同卒中类型老年缺血性脑卒中静脉溶栓患者的有效性及安全性。方法回顾性分析2018-01—2021-12郑州市中心医院卒中中心接收阿替普酶静脉溶栓治疗的老年缺血性脑卒中患者,根据TOAST病因分型将患者分为小动脉闭塞组、动脉粥样硬化组、心源性栓塞组及其他已知原因组。比较不同病因患者早期有效性及36h内出血发生率。结果共426例老年缺血性脑卒中患者入组,小动脉闭塞组171例(40.1%),大动脉粥样硬化组142例(33.4%),心源性栓塞组87例(20.4%),其他已知分型组26例(6.1%)。共174例(40.8%)患者静脉溶栓治疗后有出血,其中小动脉闭塞组51例(12.0%),动脉粥样硬化组65例(15.3%),心源性栓塞组46例(10.8%),其他已知分型组12例(2.8%),各组间早期有效率比较差异有统计学意义(χ^(2)=15.537,P=0.001)。多因素回归显示卒中分型是静脉溶栓后36h内出血的独立影响因素。结论不同类型老年缺血性脑卒中患者静脉溶栓后有效性及安全性均存在差异,临床针对不同病因的患者采取针对性的干预措施,可改善治疗效果。

Objective To investigate the efficacy and safety of intravenous thrombolysis in senile patients with different stroke types.Methods Elderly patients with ischemic stroke who received alteplase intravenous thrombolytic therapy in the Stroke Center of Zhengzhou Central Hospital from January 2018 to December 2021 were retrospectively analyzed and divided into small artery occlusion group,atherosclerosis group,cardiogenic embolism group and other groups with known causes according to TOAST etiological classification.Early effectiveness and incidence of bleeding within 36 hours were compared among patients with different etiologies.Results A total of 426 senile stroke patients with ischemic blood type were enrolled,including 171 patients(40.1%)in the small artery occlusion group,142 patients(33.4%)in the large atherosclerosis group,87 patients(20.4%)in the cardiogenic embolism group,and 26 patients(6.1%)in other known types.A total of 174 patients(40.8%)had hemorrhage after intravenous thrombolytic therapy,including 51 patients(12.0%)in the small artery occlusion group,65 patients(15.3%)in the atherosclerosis group,46 patients(10.8%)in the cardiogenic embolization group,and 12 patients(2.8%)in the other known classification group.There was significant difference in the early effective rate among all groups(χ^(2)=15.537,P=0.001).Multivariate regression results showed that stroke classification was an independent factor for bleeding within 36 hours after intravenous thrombolysis.Conclusion There are differences in the efficacy and safety of intravenous thrombolysis in elderly patients with ischemic stroke without any types.In clinical practice,patients with different etiology should take targeted intervention measures to improve the therapeutic effect.