急性脑梗死静脉溶栓后早期神经功能恶化的影响因素分析

Analysis of influencing factors of early deterioration of neurological function after intravenous thrombolysis in acute cerebral infarction

目的探讨急性脑梗死(acute cerebral infarction,ACI)患者静脉溶栓后早期神经功能恶化(early neurological deterioration,END)的影响因素。方法选取2017年1月至2021年10月北京中医药大学东直门医院经重组组织型纤溶酶原激活剂(recombinent tissue plasminogen activator,rt-PA)静脉溶栓的ACI患者188例,采用多因素logistic回归方程分析ACI患者静脉溶栓后END的影响因素。结果188例患者中男118例、女70例,年龄43~88岁,34例(18.09%)静脉溶栓后发生END。多因素logistic回归分析结果显示,溶栓前美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分越高(OR=1.185,95%CI:1.112~1.262,P=0.000)、脑小血管病(cerebral small vessel disease,CSVD)影像学总负荷评分2~4分(OR=3.352,95%CI:1.395~8.053,P=0.007)的ACI患者静脉溶栓后发生END的风险越高。结论溶栓前NIHSS评分和CSVD影像学总负荷评分是ACI患者静脉溶栓后发生END的影响因素,提示CSVD影像学总负荷评分2分或可预测ACI静脉溶栓后END的发生风险。

Objective To explore the influencing factors of early neurological deterioration(END)in patients with acute cerebral infarction(ACI)after intravenous thrombolysis.Methods A total of 188 patients with ACI who received intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in Dongzhimen Hospital Beijing University of Chinese Medicine from January 2017 to October 2021 were selected,and the influencing factors of END in patients with ACI after intravenous thrombolysis were analyzed by multivariate logistic regression equation.Results Among the 188patients,there were 118 males and 70 females,aged from 43 to 88 years.END occurred in 34 cases(18.09%)after intravenous thrombolysis.Multivariate logistic regression analysis showed that the ACI patients with higher the national institute of health stroke scale(NIHSS)score before thrombolysis(OR=1.185,95%CI:1.12-1.262,P=0.000)and cerebral small vessel disease(CSVD)total imaging load(2-4)score(OR=3.352,95%CI:1.395-8.053,P=0.007)had higher the risk of END after intravenous thrombolysis.Conclusions NIHSS score before thrombolysis and CSVD total imaging load score are influencing factors for END in ACI patients after intravenous thrombolysis.It is suggested that a CSVD imaging load score of 2 may predict the risk of END after intravenous thrombolysis in ACI.