急性缺血性脑卒中静脉溶栓预后的影响因素分析

Analysis of influencing factors on prognosis of intravenous thrombolysis in acute ischemic stroke

目的探讨急性缺血性脑卒中静脉溶栓预后的影响因素。方法80例接受静脉溶栓治疗的急性缺血性脑卒中患者,依据临床结局分为预后良好组[改良Rankin量表(mRS)评分≤2分,48例]与预后不良组(mRS评分≥3分,32例)。比较两组治疗2 d、1周及1个月后美国国立卫生研究院卒中量表(NIHSS)评分;收集两组患者临床资料,使用单因素与Logistic回归分析患者预后的影响因素。结果预后良好组治疗2 d、1周及1个月后的NIHSS评分分别为(3.26±0.14)、(2.71±0.19)、(2.27±0.13)分,均明显低于预后不良组的(6.18±0.29)、(10.28±0.31)、(14.87±0.08)分,差异有统计学意义(P<0.05)。两组性别比较,差异无统计学意义(P>0.05);预后良好组年龄≥60岁、体重≥65 kg、住院时间≥10 d、溶栓前收缩压≥140 mm Hg(1 mm Hg=0.133 kPa)及有高血压史、糖尿病史、心房颤动史占比分别为41.67%、37.50%、35.42%、37.50%、39.58%、33.33%、41.67%,均低于预后不良组的84.38%、87.50%、93.75%、90.63%、87.50%、84.38%、93.75%,差异有统计学意义(P<0.05)。Logistic回归分析显示,年龄≥60岁、体重≥65 kg、住院时间≥10 d、高血压史、糖尿病史、心房颤动史、溶栓前收缩压≥140 mm Hg是患者预后的独立危险因素(P<0.05)。结论静脉溶栓治疗急性缺血性脑卒中能够产生良好的效果;年龄、体重、住院时间、高血压史、糖尿病史、心房颤动史、溶栓前收缩压是患者预后的影响因素,需要采取有效的干预措施。

Objective To discuss the influencing factors on prognosis of intravenous thrombolysis in acute ischemic stroke.Methods 80 patients with acute ischemic stroke who received intravenous thrombolytic therapy were divided into good prognosis group[modified Ranking scale(mRS)score≤2 points,48 cases]and poor prognosis group(mRS score≥3 points,32 cases)according to clinical outcome.National Institutes of Health Stroke Scale(NIHSS)scores were compared between the two groups after 2 d,1 week and 1 month of treatment.The clinical data of the two groups were collected,and univariate and Logistic regression were used to analyze the factors affecting the prognosis of patients.Results NIHSS scores of the good prognosis group were(3.26±0.14),(2.71±0.19)and(2.27±0.13)points after 2 d,1 week and 1 month of treatment,which were significantly lower than those of(6.18±0.29),(10.28±0.31)and(14.87±0.08)points of the poor prognosis group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in gender between the two groups(P>0.05).In the good prognosis group,age≥60 years old,body weight≥65 kg,length of hospital stay≥10 d,pre-thrombolysis systolic blood pressure≥140 mm Hg(1 mm Hg=0.133 kPa),history of hypertension,diabetes and atrial fibrillation accounted for 41.67%,37.50%,35.42%,37.50%,39.58%,33.33%and 41.67%,which were lower than those of 84.38%,87.50%,93.75%,90.63%,87.50%,84.38%and 93.75%in the poor prognosis group,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that age≥60 years old,body weight≥65 kg,length of hospital stay≥10 d,history of hypertension,history of diabetes,history of atrial fibrillation and pre-thrombolytic systolic blood pressure≥140 mm Hg were independent risk factors affecting the prognosis of patients(P<0.05).Conclusion Intravenous thrombolysis in the treatment of acute ischemic stroke can produce good results;age,body weight,length of hospital stay,history of hypertension,history of diabetes,history of atrial fibrillation,and pre-thrombolysis systolic blood pressure are factors affecting the prognosis of patients,and effective intervention measures are needed.