急性脑梗死患者阿替普酶静脉溶栓后发生早期神经功能恶化的危险因素

Risk factors for early neurological deterioration after intravenous thrombolysis with Alteplase in patients with acute cerebral infarction

目的:分析急性脑梗死患者接受阿替普酶静脉溶栓后发生早期神经功能恶化(END)的危险因素。方法:回顾性分析2021年1月至2023年1月本院收治的96例急性脑梗死患者的临床资料,患者接受阿替普酶静脉溶栓24 h后美国国立卫生研究院卒中量表(NIHSS)评分较溶栓前增加≥4分判定为END,根据是否发生END分为END组(n=12)和非END组(n=84)。分别采用单因素和Logistic回归分析急性脑梗死患者静脉溶栓后发生END的危险因素。结果:两组性别、体质量指数(BMI)、吸烟史、饮酒史、合并冠心病、TOAST分型、发病至溶栓时间、PLT及Hb水平比较,差异均无统计学意义(P>0.05);END组年龄≥60岁、合并高血压、合并糖尿病、责任大血管完全闭塞、入院时NIHSS评分>21分、GCS评分≤8分占比及WBC水平均高于非END组(P<0.05);多因素Logistic回归分析结果显示,年龄≥60岁、合并糖尿病、责任大血管完全闭塞、GCS评分≤8分、入院时NIHSS评分>21分、WBC水平升高均是急性脑梗死患者溶栓后发生END的独立危险因素(OR>1,P<0.05)。结论:急性脑梗死患者接受阿替普酶静脉溶栓治疗后发生END的风险较高,年龄≥60岁、合并糖尿病、责任大血管完全闭塞、GCS评分≤8分、入院时NIHSS评分>21分、WBC水平升高均是急性脑梗死患者溶栓后发生END的独立危险因素。

Objective:To analyze risk factors of early neurological deterioration(END)in patients with acute cerebral infarction after intravenous thrombolysis with Alteplase.Methods:The clinical data of 96 patients with acute cerebral infarction admitted to this hospital from January 2021 to January 2023 were retrospectively analyzed.After 24 hours of intravenous thrombolysis with Alteplase,the patients with the increase of the National Institutes of Health stroke scale(NIHSS)score of≥4 points compared with that before thrombolysis were determined as END.According to the occurrence of END,they were divided into END group(n=12)and non-END group(n=84).The risk factors of END after intravenous thrombolysis in the patients with acute cerebral infarction were analyzed by using univariate and Logistic regression.Results:There were no significant differences in gender,BMI,smoking history,drinking history,combined coronary heart disease,TOAST classification,time from onset to thrombolysis,PLT and Hb levels between the two groups(P>0.05).The proportions of the patients with age≥60 years old,combined hypertension,combined diabetes,complete occlusion of responsible major vessels,NIHSS score>21 at admission,GCS score≤8 and the WBC level in the END group were higher than those in the non-END group(P<0.05).Multivariate Logistic regression analysis showed that age≥60 years old,combined diabetes mellitus,complete occlusion of responsible major vessels,GCS score≤8 points,NIHSS score>21 points at admission,and elevated WBC level were independent risk factors for END after thrombolysis in the patients with acute cerebral infarction(OR>1,P<0.05).Conclusions:The patients with acute cerebral infarction have a higher risk of END after intravenous thrombolysis with Alteplase.Age≥60 years old,combined diabetes mellitus,complete occlusion of responsible major vessels,GCS score≤8 points,NIHSS score>21 points at admission,and elevated WBC level are the independent risk factors for END after thrombolysis.