摘要
【目的】分析急性脑梗死（ACI）患者超早期阿替普酶（rt-PA）静脉溶栓效果及好转后恶化的影响因素分析。【方法】选择2014年1月至2016年12月于本院行超早期rt-PA治疗的70例ACI患者作为观察组，同期选择采用常规治疗的ACI患者90例作为对照组。分别于治疗前后对患者神经功能缺损情况[采用美国国立卫生研究院卒中量表（NIHSS）评定）、预后情况（Barthel指数（BI）及改良Rankin量表（mRS）3进行评价，并统计两组并发症发生率；同时将行rt-PA治疗的观察组患者按其溶栓好转后是否恶化分为恶化组（n=9）及未恶化组（n=71），收集患者人口学、既往史、实验室指标等临床资料进行单因素分析，再筛选单因素分析有差异选项行多因素Lo-gistic回归分析，探讨静脉溶栓好转后恶化的独立危险因素。【结果】治疗前，两组患者NIHSS评分、BI指数及mRS评分行组间比较，差异均无统计学意义（P〉0．05）；治疗后，两组患者NIHSS评分、BI指数及mRS评分均得到显著改善，且观察组各评分指标的改善幅度均优于对照组，差异有统计学意义（P〈0．05）。经多变量Logistic回归分析，高龄、既往房颤史、溶栓时间晚、溶栓前NIHSS评估高、白细胞计数低、完全前循环梗死均为ACI超早期rt-PA静脉溶栓好转后恶化的独立危险因素。【结论】ACI超早期rt-PA静脉溶栓能通过其溶栓机制快速纠正脑组织缺血、缺氧状态，并挽救受损神经功能，但针对溶栓治疗好转后恶化的独立危险因素也应给予高度重视。
[Objective]To analyze the effects of ultra-early alteplase （rt-PA） intravenous thrombolysis in pa- tients with acute cerebral infarction （ACI） and the influencing factors of deterioration after improvement. [Meth- ods]A total of 70 patients with ACI treated by rt-PA intravenous thrombolysis in our hospital from January 2014 to December 2016 were selected as the observation group, and 90 patients with ACI in the same period who only received conventional treatment were selected as the control group. The status of neurological impairment was e- valuated with the National Institutes of Health Stroke Scale （NIHSS） and the prognosis was evaluated with the Barthel index （BI） and modified Rankin scale （mRS）. The incidence of complications was statistically analyzed. Furthermore~ patients in the observation group were divided into the deterioration group （ n = 9） and the non-de- terioration group （n = 71）. The clinical data were collected for univariate analysis and factors with significant differences were analyzed by logistic regression analysis. [Results]Before treatment, there were no significant differences between the two groups in NIHSS score, BI and mRS scores, while after treatment, the above-men- tioned indexes were significantly improved and the improvement was more obvious in the observation group than the control group. Multivariable logistic regression analysis showed that age, previous history of atrial fibrillation, late thrombolysis, high NIHSS score before thrombolysis, low white blood cell count and total anterior circulation infarction were independent risk factors for deterioration after improvement. [Conclusion]Ultra-early rt-PA intra- venous thrombolysis can quickly correct the status of cerebral ischemia and hypoxla and save the damaged neuro- logical function in patients with ACI. Attention should be paid to the independent risk factors for deterioration after improvement.
作者
张洪
王燕萍
王红磊
ZHANG Hong;WANG Yah-ping;WANG Hong-lei(Department of Encephalopathy,Meishan Traditional Chinese Medicine Hospital, SiChuan 620010 China)
出处
《医学临床研究》
CAS
2018年第6期1115-1119,共5页
Journal of Clinical Research
