急性脑梗死患者急诊介入溶栓治疗后早期神经功能恶化影响因素分析

Analysis of Factors Influencing Early Neurological Deterioration after Emergency Interventional Thrombolysis in Patients with Acute Cerebral Infarction

目的:探讨急性脑梗死患者急诊介入溶栓治疗早期神经功能恶化(END)影响因素。方法:选择我院于2020年3月至2023年3月行急诊介入溶栓治疗的急性脑梗死患者105例,按照溶栓内24h是否发生END,分为END组34例与非END组71例。采用单因素分析影响END的相关因素;多因素Logistic回归分析影响END独立危险因素。结果:经单因素分析计数资料显示,END组和非END组性别、年龄、BMI、吸烟史、饮酒史、高血压史、糖尿病史、冠心病史和责任大血管分布差异无统计学意义(P>0.05);END组和非END组责任大血管狭窄程度比较差异具有统计学意义(P<0.05)。经单因素分析计量资料显示,END组与非END组入院时NIHSS评分、溶栓时间、白细胞计数、中性粒细胞计数、Lp-PLA2水平和脂蛋白a水平比较差异具有统计学意义(P<0.05);而END组与非END组发病至溶栓时间、D-二聚体和Hcy水平比较差异无统计学意义(P>0.05)。多因素Logistic回归分析的结果显示,责任大血管狭窄程度、入院时NIHSS评分、溶栓时间、白细胞计数、中性粒细胞计数、Lp-PLA2和脂蛋白a为影响END独立危险因素。结论:急性脑梗死患者急诊介入溶栓治疗后END发生率较高,且受多因素影响,其中责任大血管狭窄程度、入院时NIHSS评分、溶栓时间、白细胞计数、中性粒细胞计数、Lp-PLA2和脂蛋白a为影响END独立危险因素。

Objective:To investigate the factors influencing early neurological deterioration(END)after emergency interventional thrombolysis in patients with acute cerebral infarction.Methods:A total of 105 pa-tients with acute cerebral infarction who underwent emergency interventional thrombolysis in our hospital from March 2020 to March 2023 were enrolled in this study.According to whether END occurred within 24 hours after thrombolysis,the patients were divided into the END group(n=34)and the non-END group(n=71).Univariate analysis was used to analyze the factors related to END,and multivariate logistic regression analysis was used to analyze the independent risk factors for END.Results:Univariate analysis showed no significant differences between the END and non-END groups in terms of gender,age,BMI,smoking history,drinking history,hypertension history,diabetes history,coronary heart disease history,and distribution of the responsi-ble large vessel(P>0.05).However,the degree of stenosis of the responsible large vessel was significantly different between the END and non-END groups(P<0.05).Univariate analysis of the quantitative data showed that the National Institutes of Health Stroke Scale(NIHSS)score,thrombolysis time,white blood cell count,neutrophil count,Lp-PLA2 level,and lipoprotein a level were significantly different between the END and non-END groups(P<0.05).However,there were no significant differences between the END and non-END groups in terms of time from onset to thrombolysis,D-dimer level,and Hcy level(P>0.05).Multivari-ate logistic regression analysis showed that the degree of stenosis of the responsible large vessel,NIHSS score on admission,thrombolysis time,white blood cell count,neutrophil count,Lp-PLA2,and lipoprotein a were independent risk factors for END.Conclusion:The incidence of END after emergency interventional thrombol-ysis in patients with acute cerebral infarction is high and is influenced by multiple factors.The degree of steno-sis of the responsible large vessel,NIHSS score on admission,thrombolysis time,white blood cell count,neu-trophil count,Lp-PLA2,and lipoprotein a are independent risk factors for END.