影响急性脑梗死静脉溶栓治疗预后的因素

Influence factors of intravenous urokinase therapy for acute cerebral infarction

目的 探讨影响急性脑梗死静脉溶栓治疗预后的因素。方法 82例急性脑梗死患者接受尿激酶 (UK)静脉溶栓治疗。以 90d时的改良Rankin量表 (mRS)评分作为疗效指标 ,并分为二组 :预后良好 (mRS 0～ 1分 )和预后不良 (mRS 2～ 6分 ) ,对影响溶栓疗效及预后的因素进行多元Logistic回归分析。 结果 90d时预后良好者 30例 ,占 36 .6 %。单因素分析显示年龄、发病至溶栓的间隔时间、房颤、溶前欧洲卒中量表 (ESS)评分、溶前血糖、CT早期缺血改变、UK剂量为影响预后的7个危险因素 ,多因素Logistic回归表明仅溶前ESS、时间、UK剂量、血糖为预后的独立预测因子。 结论溶前ESS评分、发病至溶栓的间隔时间、UK剂量、溶前血糖为影响预后的独立危险因素。

Objective To investigate the baseline factors that influenced prognosis after intravenous thrombolytic therapy. Methods All 82 patients received intravenous urokinase (UK) for acute ischemic stroke. The modified Rankin scale score at 90 days was dichotomized into good outcome (mRS 0-1) and poor outcome (mRS 2-6) as the primary outcome measure. Multivariable logistic regression method was used to analyze independent predictors of good outcome. Results The mRS was good in 36.6% and poor in 63.4%. Univariate analysis indicated that age, time from stroke onset to treatment, atrial fibrillation, pretreatment ESS score, baseline serum glucose, early ischemic changes on baseline CT scans and dose of UK were shown correlated significantly with mRS. However, the multivariate logistic regression did select the ESS score, time to treatment, dose of UK and serum glucose as the independent predictors of good outcome. Conclusion Pretreatment ESS score, time to treatment, dose of UK and baseline serum glucose should be independently predictive of outcome in patients with acute cerebral infarction treated by intravenous UK.