轻型急性缺血性脑卒中静脉阿替普酶溶栓治疗效果分析

Effect of Intravenous Alteplase Thrombolytic Therapy on Mild Acute Ischemic Stroke

目的:探讨轻型缺血性脑卒中在溶栓时间窗内进行静脉阿替普酶溶栓治疗的有效性、安全性及溶栓后远期预后的影响因素。方法:采用回顾性研究,选取2019年09月至2022年09月就诊于厦门大学附属第一医院的MIS患者,并符合静脉rt-PA溶栓治疗的适应症及排除禁忌症,观察每位患者静脉溶栓治疗前、给药结束后、24h、7d和14d的NIHSS变化及入院时和90d的mRS评分,同时观察记录神经功能缺损恶化、溶栓后全身出血等并发症发生率,并探讨MIS患者溶栓远期预后的影响因素。结果:静脉溶栓治疗前、后NIHSS得分比较差异有统计学意义(P<0.05),溶栓后出血并发症发生率为6.32%;到观察终点,共有166例患者具有良好的远期预后(mRS 0-1分),与发病前相比,其差异有统计学意义(P<0.05);二元Logistic回归发现,影响MIS静脉rt-PA溶栓治疗远期预后主要与发病前NIHSS评分及发病类型为心源性栓塞相关(P<0.05),而与发病前是否致残无明显相关。结论:MIS患者4.5h内实施静脉rt-PA溶栓治疗可能改善远期预后;就诊时NIHSS评分越高,其溶栓后远期预后可能越差;心源性栓塞可能是影响MIS患者溶栓远期预后的独立危险因素。

Objective:Objective to explore the effects of Mild ischemic stroke on thrombolysis time window efficacy,safety and long-term prognosis of Recombinant tissue-type plasminogen activator(rt-PA)thrombolytic therapy.Method:A retrospective study was conducted to select MIS patients admitted to the First Affiliated Hospital of Xiamen University from September 2019 to September 2022,who met the indications for intravenous rt-PA thrombolytic therapy,and corresponding contraindications were excluded.The National Institute of Health Stroke Scale,Modified Rankin Scale at the time of admission and 90 days,and the occurrence of complications such as worsening of neurological deficits and systemic bleeding after thrombolysis were observed and recorded.Therefore,to observe the efficacy and safety of intravenous rt-PA thrombolytic therapy in MIS patients,and to explore the factors affecting the long-term prognosis of MIS patients.Result:For 190 MIS patients who were included in retrospective case-control cohort study,there was a statistically significant difference in NIHSS between intravenousa rt-PA treatment before and after intravenous thrombolysis(P<0.05),and the incidence of bleeding complications after thrombolysis was 6.32%.By the end of observation,166patients had mRS 0-1 scores,and the difference was statistically significant compared with before the onset(P<0.05).Multivariate binary Logistic regression showed that the influence of MIS intravenous rt-PA thrombolytic therapy on the long-term prognosis was mainly related to the pre-onset NIHSS score and the onset type of cardiac embolism(P<0.05),but had no significant correlation with ONT.Conclusion:Intravenous rt-PA thrombolytic therapy within 4.5h may improve the long-term prognosis of MIS patients;The higher the NIHSS score at treatment,the worse the long-term prognosis after thrombolysis;Cardiogenic embolism may be an independent risk factor for the long term prognosis of patients with MIS.