急性重症脑梗死静脉溶栓患者 预后影响因素的分析

Analysis of prognostic factors in patients with acute severe cerebral infarction intravenous thrombolysis

摘要:

目的 观察新发的重症脑梗死患者溶栓前后动态脑电图的变化，为重症脑梗死患者的预后提供参 考。方法 选取2015 年1 月—2016 年12 月于乐山市人民医院就诊的符合重组组织型纤溶酶原激活剂静脉溶 栓标准的98 例重症脑梗死患者，监测患者动态脑电图溶栓前后脑电波的变化。详细记录患者的一般资料、溶 栓前后脑电图及头颅影像学检查结果。用Excel 建立数据库，应用单变量和Logistic 回归分析判断重症脑梗死 患者的预后。结果 两组患者年龄、发病至就诊时间、脑电图检查及头颅影像学检查结果比较，差异有统计 学意义（P <0.05）；多因素Logistic 回归分析显示，重症脑梗死患者年龄≥ 65 岁[Ol ^ R=2.958（95% CI ：1.347， 6.495）]、发病至就诊时间>3.5 h[Ol ^ R=3.643（95% CI ：0.563，5.267）] 脑电图检查阳性[Ol ^ R=4.079（95% CI ：1.588，10.477）]、头颅影像学检查阳性[Ol ^ R=3.021（95% CI ：1.554，5.870）] 是预后差的独立危险因素。 结论 入组前年龄>65 岁、溶栓后脑电图波形异常及头颅影像学检查结果异常是重症脑梗死患者预后差的独 立危险因素。将动态脑电图监测应用于重症脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓，对于预测重症 脑梗死患者的预后具有重大意义。

Abstract:

Objective To observe the changes of dynamic video EEG before and after thrombolysis in patients with newly discovered severe cerebral infarction, and to provide more positive opinions and suggestions for the prognosis of patients with severe cerebral infarction. Methods We selected 98 patients with severe cerebral infarction who were newly diagnosed with rt-PA intravenous thrombolysis criteria at the Leshan City People’s Hospital between January, 2015 and December, 2016. The changes of EEG before and after thrombolysis were monitored. The general data, EEG before and after thrombolysis, and the results of skull imaging were recorded in detail. The prognosis of patients with severe cerebral infarction was evaluated by single variable and logistic regression analysis. Results In the univariate analysis, there were significant differences in age, onset-to-visit time, EEG and cranial imaging findings between the remission group and the unremission group in terms of statistics (P < 0.05). By multivariate Logistic regression analysis, age older than 65 years old [Ol^R=2.958, (95% CI: 1.347, 6.495)], time for onset to visit >3.5 h [Ol^R=3.643, (95% CI: 0.563, 5.267)] EEG positive [Ol^R=4.079, (95% CI: 1.588, 10.477)], head imaging positive [Ol^R=3.021, (95% CI: 1.554, 5.870)] were independent risk factors of poor prognosis. Conclusions The age >65 years before admission, abnormal EEG waveform after thrombolysis and abnormal cranial imaging findings are the independent risk factors for poor prognosis of patients with severe cerebral infarction. The application of dynamic video EEG monitoring to rt-PA thrombolytic therapy in patients with severe cerebral infarction is of great significance in predicting the prognosis of patients with severe cerebral infarction.