急性脑梗死静脉溶栓早期治疗效果的多因素分析

目的 探讨影响脑梗死患者的基线情况与其静脉溶栓早期治疗效果的关系.方法 回顾性分析71例行静脉溶栓的急性脑梗死患者的临床资料,以静脉溶栓后24h的美国国立卫生院卒中量表(NIHSS)评分较溶栓前减少≥4分或神经功能缺损症状完全消失视为有效,比较有效组和无效组患者的年龄、性别、高血压病史、糖尿病病史、房颤、吸烟,发病至溶栓的间隔时间,溶栓前平均动脉压、溶栓前血糖、溶栓前纤维蛋白原、溶栓前NIHSS评分、溶栓药物类型,使用Logistic回归分析以上与溶栓早期治疗效果有关的因素.结果 静脉溶栓早期有效率为40.8％ (29/71).有效组在3h内接受溶栓的患者比率高于无效组(55.2％ vs 21.4％,P=0.003),而心房颤动的比率低于无效组(6.9％ vs 26.2％,P=0.039).Logistic回归分析显示发病至溶栓间隔时间(＜3 h)与早期神经功能障碍改善独立相关(OR =0.161,95％ CI:0.148-0.533,P=0.003),而心房颤动则是其危险因素(OR=8.666,95％ CI:1.482～ 50.688,P=0.017).结论 脑梗死急性期静脉溶栓早期治疗效果与发病至溶栓间隔时间及是否伴心房颤动相关.

Analysis of factors related to early treatment outcome after intravenous thrombolysis in patients with acute cerebral infarction

Objective To investigate the baseline factors that were related to the early treatment outcome after intravenous thrombolysis in patients with acute cerebral infarction. Methods Retrospectively analyze the data of all 71 patients who had received intravenous thrombolytic therapy. Early good outcome （EGO） was defined by an 4-point improvement in national institute of health stroke scale （NIHSS） score or complete recovery at 24 h. Age, sex, history of hypertension and diabetes mellitus, smoking, atrial fibrillation,time from onset to treatment, baseline mean artery pressure, serum glucose , serum fibrinogen , NIHSS scores and type of thrombolytic medications were compared between patients with and without EGO. Logistic regression analysis was used to determine the independent factors associated to the EGO. Results Twenty-five patients 40. 8% （29/71） had EGO. As compared to patients without EGO, patients with EGO had higher proportion of receiving thrombolytic therapy within 3 h （55.2% vs 21.4%, P = 0. 003 ） and lower proportion of atrial fibrillation （6.9% vs 26.2%, P = 0. 039）. Multiple logistic regression analysis showed that time from onset to treatment（ 〈3 h） （OR =0. 161,95% CI：0. 148 -0. 533,P =0. 003） and atrial fibrillation（ OR = 8. 666,95% CI：I. 482 -50. 688, P = 0. 017 ）were independent factors that influenced the EGO. Conclusions Time from onset to treatment and atrial fibrillation are baseline factors that influenced the early treatment outcome after intravenous thrombolysis in patients with acute cerebral infarction.