关急性缺血性脑卒中患者阻塞部位与功能恢复相

目的：探讨重组组织型纤溶酶原激活剂（ rt－PA）治疗急性缺血性脑卒中后临床症状轻度改善时间是否可以预测1年后功能恢复情况。方法186例急性大脑前循环梗塞患者，且发病3 h内接受rt－PA治疗，作为研究对象。患者根据临床症状轻度改善时间可以分为：早期见效者（ ER），即rt－PA治疗2 h内NIHSS评分改善≥4或其中一项NIHSS评分为0；晚期见效者（ LR）， rt－PA治疗2 h－24 h内，NIHSS评分改善≥4或其中一项NIHSS评分为0；无效果者（ NR）。此外，根据患者动脉阻塞部位分为：颈内动脉和大脑中动脉M1段近端（ P组）；大脑中动脉M1、M2段远端（ D组）。结果 P组包括96例（52％）患者， D组包括90例（48％）患者。76例（41％）患者属于ER，40例（22％）患者是LR，70例（38％）患者为NR。多元线性回归分析显示，P组（OR：3.04；95％CI：1.18－10.45； P＝0.031）和NR （OR：4.14；95％ CI，1.29－14.27； P＝0.014）是1年后临床功能恢复较差的独立预测因素。 ER （53％， P＝0.01）和LR （55％， P＝0.01）患者临床功能恢复比例高于NR （23％）患者，ER和LR临床功能恢复率无显著统计学意义。结论早期轻度临床症状改善不能预测脑梗塞后1年功能恢复，但是阻塞部位是rt－PA治疗后功能恢复的有效预测因素。

Association Between the Occlusion Site and Functional Outcome in Patients with Acute Ischemic Stroke

Objective To examined whether the timing of clinical improvement after recombinant tissue plasminogen activator ( rt-PA) predicted the clinical outcome at 1 year after acute ischemic stroke.Methods 186 patients with a-cute cerebral infarction in the anterior circulation who received rt-PA treatment within 3 hours of the onset of symptoms were enrolled in the study.Patients were classified according to the timing of clinical improvement [ early responder ( ER) , National Institutes of Health Stroke Scale ( NIHSS) score improved≥4 points or who had a score of 0 within 2 hours after rt-PA;late responder ( LR) , a similar improvement between 2 and 24 hours;and non-responder ( NR) ] and according to the arterial occlusion site ( P group, proximal middle cerebral artery M1 region;and D group, distal M1 and M2).Results The P group consisted of 96 (52%) patients and the D group consisted of 90(48%) patients.76 patients (41%) were classified as ERs, 40 (22%) as LRs, and 70 (38%) as NRs.On a multivariate regression anal-ysis, the P group [odds ratio (OR), 3.04;95%confidence interval (CI), 1.08-10.45;P=0.031] and NR (OR, 4.14;95%CI, 1.29-14.27;P=0.014) were independent predictors of a poor outcome.ER (47%, P=0.01) and LR (45%, P=0.01) patients showed fewer poor outcomes than NR (77%) patients, but the rate did not differ signifi-cantly between the ER and LR patients.Conclusions Early mild clinical recovery did not predict a good outcome.The occlusion site was a stronger predictor of clinical improvement after rt -PA administration.