基层医院急性脑梗死静脉溶栓治疗后发生早期神经功能恶化的影响因素及不良预后分析

Analysis of Influencing Factors and Adverse Prognosis of Early Neurological Deterioration After Intravenous Thrombolytic Therapy for Acute Cerebral Infarction in Primary Hospitals

目的 研究基层医院急性脑梗死静脉溶栓治疗后发生早期神经功能恶化(END)的影响因素,并分析END的不良预后。方法 选取2021年5月至2022年7月大连市普兰店区中心医院收治的急性脑梗死静脉溶栓患者133例作为研究样本,回顾性统计分析入选样本中END发生率,将发生END的归为END组(18例),将未发生END的归为非END组(115例),并回顾性对比各组一般资料,将有差异项带入Logistic回归方程,探讨END形成原因,计算、分析END的不良预后发生情况,据此提出预防END及不良预后的针对性建议。结果 入选患者中END发生例数为18例,发生率为13.53%。两组在年龄、高血压、糖尿病、房颤、发病至溶栓时间、责任大血管狭窄闭塞、入液量方面对比有差异(P <0.05),将上述因素带入Logistic回归方程计算发现,除高血压外,上述情况均是引起END的影响因素。结论 基层医院急性脑梗死静脉溶栓患者中约有13.53%的患者易发生END,且不良预后症状是导致患者治疗效果认同度偏低及就诊满意度不理想的主要原因,基层医院相关医学从业者应对END及其不良预后的预防工作予以高度重视,神经科医师应对END的发生准确预判,对其影响因素尽早干预,以降低END的发生率,提高溶栓的治愈率,挽救更多神经功能,提高患者对溶栓的满意度,增强全民战胜脑梗死的信心,让更多脑梗死患者获益。

Objective To study the influential factors of early neurologic deterioration(END) after intravenous thrombolysis of acute cerebral infarction in primary hospitals,and to analyze the poor prognosis of END.Methods Patients with acute cerebral infarction treated in Dalian Pulandian District Central Hospital from May 2021 to July 2022(n=133) were selected as study samples.The incidence of END in the selected samples was retrospectively analyzed statistically.Those with END were classified as END group(n=18),and those without END were classified as non-end group(n=115).The general data of each group were retrospectively compared,and the differences were brought into the Logistic regression equation to explore the causes of the formation of END,calculate and analyze the occurrence of adverse prognosis of END,and put forward targeted suggestions on the prevention of END and adverse prognosis.Results There were 18 cases of END in the selected patients,the incidence was 13.53%.There were differences between the two groups in age,hypertension,diabetes,atrial fibrillation,time from onset to thrombolytic,stenosis and occlusion of major responsible vessels,and fluid intake(P<0.05).Logistic regression equation was used to calculate the above factors,and it was found that,except hypertension,the above conditions were all influential factors causing END.Conclusions About 13.53% of the patients with acute cerebral infarction in primary hospitals are prone to END,and the poor prognosis symptoms are the main reasons leading to the low recognition of the treatment effect of patients and unsatisfactory satisfaction with treatment.Relevant medical practitioners in primary hospitals should attach great importance to the prevention of END and its poor prognosis.Through the implementation of targeted intervention measures to avoid the occurrence of END as far as possible,enhance patients' willingness to follow-up thrombolytic therapy in primary hospitals,inhibit the progression of nervous system injury,improve their satisfaction,and benefit more cerebral infarction patients.Neurologists should accurately predict the occurrence of END and intervene as early as possible on the factors affecting it,in order to reduce the incidence of END,improve the cure rate of thrombolysis,save more neurological functions,increase patient satisfaction with thrombolysis,and enhance the confidence of the whole population in overcoming cerebral infarction,so that more patients with cerebral infarction can be benefited.