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[1]孙乾镤,白永生.急性脑梗死早期rtPA溶栓后疗效及预后的影响因素分析[J].宁夏医科大学学报,2019,(12):1195-1200.[doi:10.16050/j.cnki.issn1674-6309.2019.12.002]
 SUN Qianpu,BAI Yongsheng.Analysis the Influence Factors of the Efficacy and Prognosis after rtPA Thrombolysis in Patients with Acute Cerebral Infarction[J].Ningxia Medical University,2019,(12):1195-1200.[doi:10.16050/j.cnki.issn1674-6309.2019.12.002]
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急性脑梗死早期rtPA溶栓后疗效及预后的影响因素分析(PDF)
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《宁夏医科大学学报》[ISSN:1005-8486/CN:64-1029/R]

卷:
期数:
2019年12期
页码:
1195-1200
栏目:
论著
出版日期:
2020-03-27

文章信息/Info

Title:
Analysis the Influence Factors of the Efficacy and Prognosis after rtPA Thrombolysis in Patients with Acute Cerebral Infarction
文章编号:
1674-6309(2019)12-1195-06
作者:
孙乾镤1 白永生2
(1. 宁夏西吉县中医医院大内科,西吉 756200; 2. 宁夏回族自治区人民医院神经内科,银川 750021)
Author(s):
SUN Qianpu1 BAI Yongsheng2
(1. Department of Internal Medicine,Xiji County Hospital of Traditional Chinese Medicine,Xiji 756200,China; 2. Department of Neurology,People's Hospital of Ningxia Hui Autonomous Region,Yinchuan 750021,China)
关键词:
急性脑梗死重组组织型纤溶酶原激活剂疗效预后影响因素
Keywords:
acute cerebral infarction recombinant tissue plasminogen activatorefficacy prognosisinfluence factor
分类号:
R743.32
DOI:
10.16050/j.cnki.issn1674-6309.2019.12.002
文献标志码:
A
摘要:
目的 分析影响急性脑梗死早期重组组织型纤维蛋白酶原激活剂(recombinant tissue plasminogen activator, rtPA)静脉溶栓治疗的临床疗效及预后的影响因素。方法 回顾性分析2013年1月至2018年1月我院收治的急性脑梗死患者213例,记录患者性别、年龄、牛津郡社区卒中计划(oxfordshire community stroke project,OCSP)分型、美国国立卫生研究院卒中量表(National institutes of health stroke scale, NIHSS)评分、有无合并糖尿病、房颤、冠心病以及溶栓时间等基线资料。出院后电话或者门诊随访,应用改良Rankin量表(modified rankin scale,mRS)评分评估预后(mRS<2表示预后良好,2≤mRS≤5表示残疾),并记录溶栓后48 h内脑出血和6个月死亡率等随访指标。采用多重方差评价溶栓的效果,并对差异指标进行简单分析校准;应用Logistic回归分析临床指标与预后指标的关系。结果 213例急性脑梗死患者中,女性74例,男性139例;OCSP分型前循环62例,后循环151例;梗死分型中非腔隙性梗死123例,腔隙性梗死90例。急性脑梗死患者溶栓前、溶栓后即刻、溶栓24 h后和溶栓14 d后的NIHSS评分分别为(10.49±7.22)、(9.81±7.25)、(9.85±8.35)和(8.45±9.20)分,患者合并糖尿病、房颤以及溶栓时间影响rtPA静脉溶栓的疗效(P<0.05);房颤、后循环梗死、溶栓时间超过4.5 h和腔隙性梗死与溶栓后脑出血有相关性(P均<0.05);溶栓后残疾(mRS)分级与房颤和脑梗死类型有关(P均<0.05);糖尿病、房颤、溶栓前NIHSS评分和梗死类型与溶栓后死亡有关(P均<0.05)。结论 急性脑梗死患者早期rtPA静脉溶栓的临床效果显著,疗效确定;但受到糖尿病、房颤以及溶栓时间的影响;糖尿病、房颤、溶栓时间、梗死类型以及溶栓前NIHSS评分为影响急性脑梗死患者rtPA静脉溶栓治疗后不良预后的影响因素。
Abstract:
Objective To analysis of the clinical effects and prognostic factors of recombinant tissue plasminogen activator(rtPA) intravenous thrombolytic therapy in patients with acute cerebral infarction. Methods A retrospective analysis of 213 patients with acute cerebral infarction admitted to our hospital from January 2013 to January 2018 was made. The patients' gender,age,OCSP classification,NIHSS score,diabetes mellitus,atrial fibrillation and coronary heart disease and thrombolysis time were recorded. After discharge,patients were followed up by telephone or clinic. The prognosis was evaluated by modified Rankin Scale(MRS<2 for good prognosis,2≤Mrs≤5 for disability),and the follow-up indexes such as cerebral hemorrhage within 48 hours after thrombolysis and 6-month mortality were recorded. The effect of thrombolysis was evaluated by multiple variance, and the difference indexes were adjusted by simple analysis;the relationship between clinical indexes and prognosis indexes was analyzed by logistic regression. Results Among 213 patients with acute cerebral infarction,74 were female,139 were male;62 were anterior circulation and 151 were posterior circulation;123 were non lacunar infarction and 90 lacunar infarction. The NIHSS scores of patients with acute cerebral infarction were(10.49±7.22)before thrombolysis,(9.81±7.25)after thrombolysis, 9.85±8.35 after thrombolysis for 24 hours, and(14.45±9.20)after thrombolysis for 14 days, the NIHSS score after thrombolysis was obvious reduced(P<0.05). Diabetes,thrombolysis time and atrial fibrillation affected the effect of urokinase thrombolysis. Cerebral hemorrhage had a significant correlation with atrial fibrillation,posterior circulation infarction,thrombolysis time over 4.5 hours and complete circulation infarction(P<0.05). Post-thrombolytic disability(mRS)classification was associated with atrial fibrillation and cerebral infarction type(P all<0.05). Diabetes mellitus, atrial fibrillation,pre-thrombolytic NIHSS score and lacunar infarction were significantly correlated with post-thrombolytic death(P all<0.05). Conclusion In patients with acute cerebral infarction,early rtPA intravenous thrombolysis has a significant clinical effect and definite efficacy. However,it is affected by diabetes, atrial fibrillation and thrombolysis time. Diabetes,atrial fibrillation,thrombolysis time,infarction type and pre-thrombotic NIHSS score are risk factors of poor prognosis after rtPA intravenous thrombolytic therapy in patients with acute cerebral infarction.

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备注/Memo

备注/Memo:
收稿日期:2019-01-29
基金项目:国家自然科学基金(8176020242)
作者简介:孙乾镤(1973-),男,宁夏人,副主任医师,从事内科临床与研究。
通信作者:白永生(1974-),男,宁夏人,博士,主任医师,从事缺血性脑血管病疾病的临床与研究。E-mail:getty571@sohu.com
更新日期/Last Update: 2019-12-30