急性缺血性卒中动脉溶栓治疗的远期转归及其影响因素分析

目的 探讨急性缺血性卒中动脉溶栓治疗的远期转归和影响因素.方法 选取采用动脉溶栓治疗的80例急性缺血性卒中患者,在90d时以改良Rankin量表（Modified Rankin Scale,mRS）评价神经功能,将评分0～2分的患者作为转归良好者,将评分3～6分的患者作为转归不良者.根据急性心肌梗死溶栓实验（Thrombolysis in Myocardial Infarction,TIMI）分级标准评定血管再通程度,观察治疗后7d内颅内出血的发生率.利用单变量分析和多变量Logistic回归分析筛选动脉溶栓远期转归的影响因素.结果 接受动脉溶栓治疗的80例患者中,75例完成最终研究,转归良好者36例（48.0％）,转归不良者39例（52.0％）;血管再通良好者48例（64.0％）,23例（30.7％）7 d内出现颅内出血.单变量分析：基线血糖值（P=0.001）,NIHSS评分（P=0.847）,血管再通情况（P=0.002）,有症状颅内出血均可影响远期转归（P=0.001）.多变量Logistic回归分析：基线血糖水平较低（P=0.033）和血管再通良好（P=0.006）是远期转归良好的独立预测因素.结论 急性缺血性脑卒中患者在满足一定条件下进行动脉溶栓治疗是安全有效的,基线血糖值和治疗后血管再通情况是影响其远期转归的预测因素.

Long-term outcome of intra-arterial thrombolysis for acute Ischemic stroke and its influencing factors

Objective To investigate the long-term outcome of intra-arterial thrombolysis in patients with acute ischemic stroke and its influencing factors.Methods Patients with acute ischemic stroke who received intra-arterial thrombolysis were selected for this study.The neurological function was assessed by using the modified Rankin Scale （mRS）.Patients scored 0～2 were divided into the good outcome group,and patients scored 3～6 were divided into the poor outcome group.The degree of recanalization after thrombolysis was assessed by the grading criteria of the Thrombolysis in Myocardial Infarction （TIMI） trial,the incidence of intracerebral hemorrhage within 7 days after thrombolytic therapy was observed.Univariate analysis and multivariate logistic regression analysis were used to screen the influencing factors of long-term outcome of arterial thrombolysis.Results In the all 80 patients who received intra-arterial thrombolysis,75 patients have finished the research,including 36 patients （48.0%） with good outcome and 39 patients （52.0%） with poor outcome after intra-arterial thrombolysis.Forty-eighit patients （64.0%） had good recanalization （TIMI grade,2～3）,and 23 patients （30.7%） occurred intracranial hemorrhage within 7 days.The baseline blood glucose levels （P=0.009）,the baseline National Institutes of Health Stroke Scale （NIHSS） sores （P=0.001）,the degree of recanalization （P=0.002） and symptomatic intracranial hemorrhage （P=0.001） could influence the long term outcome of patients with intra-arterial thrombolysis.The lower level of baseline glucose （P=0.033） and good recanalization （P=0.006） were the independent predictive factors of the good long-term outcome.Conclusion In certain conditions,it is safe and effective to receive intra-arterial thrombolysis for the patients with acute ischemic stroke.The baseline blood glucose levels and the degree of recanalization are the independent predictive factors of the long-term outcome.