时间窗内阿替普酶溶栓治疗急性脑梗死的疗效分析

Therapeutic effect of alteplase thrombolytic therapy in time window

摘要:

目的 探讨时间窗内阿替普酶溶栓治疗急性脑梗死的效果及神经功能恶化的危险因素。方法 选取2016年8月—2017年12月在衡水市人民医院就诊的急性脑梗死患者143例为研究对象。收集患者的性别，年龄，体重指数，个人史，合并症，基线美国国立卫生研究院卒中量表（NIHSS）评分，发病至溶栓时间，基线血压、血糖、低密度脂蛋白水平，观察上述指标与患者溶栓结局的关系。结果 143例患者中84例（58.74%）结局良好（结局良好组），结局不良患者59例（41.26%）（结局不良组）。单因素分析显示，两组的饮酒、房颤史、基线收缩压和基线舒张压比较，差异无统计学意义（P >0.05）；两组的性别、年龄、体重指数、吸烟、发病至溶栓时间、高血压、糖尿病、高脂血症、基线NIHSS评分、基线血糖、基线低密度脂蛋白比较，差异有统计学意义（P <0.05）。发病至溶栓时间［R=4.274（95% CI：2.085，8.169）］、基线NIHSS评分［R=1.459（95%CI：1.238，2.054）］、基线血糖［R=1.794（95% CI：1.317，2.576）］和基线低密度脂蛋白［R=2.246（95% CI：1.872，3.417）］是导致溶栓结局不良的危险因素。结论 发病至溶栓时间、基线NIHSS评分、基线血糖、基线低密度脂蛋白是导致溶栓结局不良的独立危险因素，对急性脑梗死患者静脉溶栓前应综合考虑这些因素，并进行针对性干预，以改善静脉溶栓的预后。

Abstract:

Objective To investigate the efficacy of Ateppase thrombolysis in the treatment of acute cerebral infarction (ACI) and the risk factors of neurological deterioration in the time window.Methods From August 2016 to December 2017, 143 patients with acute cerebral infarction were selected as the subjects. The sex, age, body mass index, personal history, complications, pre-treatment NIHSS score, and onset to thrombolysis time were collected. Baseline blood pressure, blood glucose, and low density lipoprotein (LDL) levels were observed. The correlation of the above indexes with prognosis and thrombolytic outcome were observed.Results Among the 143 patients, 84 had good outcomes, accounting for 58.74%, and 59 patients with poor outcomes, accounting for 41.26%. Univariate analysis showed no significant differences in drinking, history of atrial fibrillation, baseline systolic blood pressure, and baseline diastolic blood pressure (P > 0.05). There were statistically significant differences in gender, age, body mass index, smoking, onset to thrombolytic time, hypertension, diabetes, hyperlipidemia, baseline NIHSS score, baseline blood glucose, and baseline low density lipoprotein (P < 0.05). Time from onset to thrombolysis [R = 4.274 (95% CI: 2.085, 8.169)], baseline NIHSS score [R = 1.459 (95% CI: 1.238, 2.054)], baseline blood glucose [R = 1.794 (95% CI: 1.317, 2.576)], and toxic low-density lipoprotein [R = 2.246 (95% CI: 1.872, 3.417)] are risk factors that lead to poor thrombolytic outcomes (P < 0.05).Conclusion The time from onset to thrombolysis, baseline NIHSS score, baseline blood glucose, and baseline low-density lipoprotein are independent risk factors that lead to poor thrombolytic outcome. Clinically, these factors should be considered comprehensively before clinical thrombolysis of patients with acute cerebral infarction and focused to make interventions to improve the prognosis of intravenous thrombolysis.