摘要
目的 探讨急性脑梗死患者静脉溶栓后早期神经功能改善及病情变化的影响因素。方法 回顾性分析128例急性脑梗死静脉溶栓患者的临床资料,静脉溶栓后24 h及7 d,根据美国国立卫生研究院卒中量表（NIHSS评分）改善≥40%或NIHSS评分0~1分视为溶栓显效,比较显效组和非显效组患者的年龄、性别、高血压病史、糖尿病病史、溶栓时间窗、溶栓前血小板、血糖、血脂、溶栓前NIHSS评分等因素,应用logistic回归分析以上因素与静脉溶栓后早期功能改善及病情变化的关系。结果 静脉溶栓后24 h显效率为39.1%,溶栓时间窗是溶栓显效的独立影响因素（OR=2.876,95%CI：1.096~7.542,P=0.032）。溶栓后7 d显效率为53.1%,溶栓时间窗（OR=2.516,95%CI：1.025~6.179,P=0.044）,溶栓前NIHSS评分（OR=1.144,95%CI：1.056~1.239,P=0.001）,溶栓前血糖（OR=1.149,95%CI：1.034~1.288,P=0.010）是溶栓效果的独立影响因素。结论 溶栓时间窗≤3 h、基线NIHSS评分〈8分、基线血糖≤7.8 mmol/L对静脉溶栓后早期神经功能改善有益,后两者为影响溶栓后早期病情变化的因素。
Objective To investigate the factors associated with early neurologic improvement and changes after intravenous thrombolysis in patients with acute ischemic stroke. Methods The data of all 128 patients who had received intravenous thrombolytic therapy were retrospectively analyzed. Early neurological improvement （ENI） was defined by a 40% improvement in national institute of health stroke scale （NIHSS） score or NIHSS 0-1 at 24 h and 7d. Age, sex, his- tory of hypertension and diabetes mellitus, time from onset to treatment, baseline platelet counts, serum glucose level, blood lipid level, NIHSS scores, et al, were compared between patients with and without ENI. Logistic regression analysis was used to determine the independent factors associated with the ENI and condition change. Results At 24 h after throm- bolysis, 50 patients （39.1%） had ENI. Multiple logistic regression analysis showed that the time from onset to treatment （〈 3 h） was an independent factor that influenced the ENI（OR = 2.876, 95% CI： 1.096-7.542, P = 0.032）. On 7 d after thrombolysis, 68 patients （53.1%） had ENI. Multiple logistic regression analysis showed that the time fi＇om onset to treat- ment （ 〈 3 h） （OR = 2.516, 95% CI： 1.025 - 6.179, P = 0.044）, baseline NIHSS （OR = 1.144, 95% CI： 1.056 - 1.239, P = 0.001） and baseline serum glucose level（OR = 1.149, 95% CI：1.034 - 1.288, P = 0.010） were independent factors that in- fluenced the ENI. Conclusion Time from onset to treatment less than 3 h, baseline NIHSS less than8 and baseline serum glucose level lower than 7.8 mmol/L are beneficial for early neurologic improvement after intravenous thrombolysis, and the latter two factors are related to the condition changes 24 h to 7 d after thrombolysis in patients with acute cerebral in- farction.
出处
《北京医学》
CAS
2016年第3期218-221,共4页
Beijing Medical Journal
关键词
脑梗死
静脉溶栓
神经功能
影响因素
Acute cerebral infarction Thrombolytic therapy Neurologic function Influence factor
