阿替普酶静脉溶栓治疗急性脑梗死预后的影响因素分析

目的:分析影响阿替普酶(重组组织型纤溶酶原激活剂,rt-PA)静脉溶栓治疗急性脑梗死预后的因素。方法:接受rt-PA静脉溶栓治疗的46例急性脑梗死患者按治疗后第90日改良Rankin量表(mRS)评分,分为预后良好组(mRS评分0～1分)及预后不良组(mRS评分2～6分),比较两组患者的临床资料,采用Logistic回归分析影响预后的危险因素。结果:预后良好组(19例)与预后不良组(27例)相比,合并房颤率低(P=0.031),溶栓前血糖较低(P=0.001),CT示早期缺血率低(P=0.043),溶栓前美国国立卫生研究院卒中量表(NIHSS)低(P=0.001),发病至溶栓开始的时间短(P=0.001)。Logistic回归分析表明溶栓前NIHSS低、发病至溶栓开始的时间短、溶栓前血糖低是预后的独立预测因素。结论:溶栓前NIHSS低、发病至溶栓开始的时间短、溶栓前血糖低是影响rt-PA静脉溶栓治疗急性脑梗死预后的独立预测因素。

Analysis on prognostic predictors of introvenous thrombolysis with alteplase for acute ischemic stroke

Objective： To analyze the prognostic risk factors of introvenous thrombolysis with alteplase for acute ischemic stroke.Methods： Forty-six patients of acute ischemic stroke treated with introvenous alteplase were divided into two groups according to modified rankin scale（mRS） score 90 days after treatment.MRS score of 0 to 1 was defined as good outcome and mRS score of 2 to 6 as poor outcome.The baseline characteristics were compared between two groups and the prognostic risk factors were analyzed via logistic regression.Results： The morbidity of atrial fibrillation（P=0.031）,blood glucose level（P=0.001）,early ischemic changes on CT（P=0.043）,baseline NIHSS score（P=0.001）and time span from stroke onset to the start of treatment（P=0.001）were lower in patients with good outcome（19 cases） than those with poor outcome（27 cases）.Logistic regression analysis showed that high baseline NIHSS score,long time span from stroke onset to the start of treatment and high blood glucose were related to poor outcome independently.Conclusions： The baseline NIHSS score,time span from stroke onset to the start of treatment,level of blood glucose are independent prognostic risk factors of introvenous thrombolysis with alteplase for acute ischemic stroke.