摘要
目的评估美国国立卫生研究院卒中量表(NIHSS)评分和格拉斯哥昏迷(GCS)评分对急性脑梗死患者溶栓治疗后出血的预测价值。方法共纳入河南省人民医院急性脑梗死患者281例,采用尿激酶或重组人组织型纤溶酶原激活剂(rt-PA)进行溶栓,患者随访至溶栓后1个月,根据溶栓后出血情况将患者分为溶栓后出血组69例与未出血组212例,记录患者年龄、性别、发病至溶栓时长、吸烟、收缩压、血小板、凝血酶原时间、国际标准化比值、NIHSS与GCS评分等指标,应用Logistic回归分析急性脑梗死溶栓后出血的相关因素,利用受试者工作特征曲线(ROC)评估相关因素的预测价值,并计算曲线下面积(AUC)。结果Logistic回归分析结果显示,发病至溶栓时长、溶栓前凝血酶原时间、溶栓前NIHSS评分、溶栓后24 h NIHSS评分、溶栓前GCS评分、溶栓后24 h GCS评分是患者溶栓后出血的独立相关因素(OR=23.318.0.238.17.099、4.561.0.004.0.258,P=0.038、0.021、0.038、0.027、0.006、0.040)。ROC曲线分析结果显示,溶栓前NIHSS评分、溶栓后24 h NIHSS评分、发病至溶栓时长是预测患者溶栓后出血的重要因素(AUC=0.833.0.795.0.714,均P=0.000)。结论对于急性脑梗死患者,溶栓前及溶栓后24 h NIHSS评分较差、急性脑梗死时间较长则患者溶栓后出血的风险明显增高,应重点关注并尽早进行干预。
Objective To evaluate the predictive value of the National Institutes of Health Stroke Scale(NIHSS)score and the Glasgow Coma Scale(GCS)score for bleeding in patients with acute cerebral infarction after thrombolytic therapy.Methods A total of 281 patients with acute cerebral infarction were enrolled at Henan Provincial People's Hospital and were treated with urokinase or recombinant human tissue plasminogen activator(rt-PA)for thrombolysis.The patients were followed up for up to 1 month after thrombolysis.Data on age,sex,time to thrombolysis,smoking,systolic blood pressure,platelets,prothrombin time,international normalized ratio,and NIHSS and GCS scores were collected.Logistic regression analysis was used to identify related factors for bleeding after thrombolysis in acute cerebral infarction and the receiver-operating characteristic curve(ROC)was used to assess the predictive values of these factors through calculating the area under the curve(AUC).Results Logistic regression analysis showed that time to thrombolysis,prothrombin time before thrombolysis,NIHSS score before thrombolysis,NIHSS score 24 h after thrombolysis,GCS score before thrombolysis,and GCS score 24 h after thrombolysis were independent factors for hemorrhage after thrombolytic therapy(0R=23.318,0.238,17.099,4.561,0.004,and 0.258,P=0.038,0.021,0.038,0.027,0.006,and 0.040,respectively).ROC curve analysis showed that NIHSS score before thrombolysis,NIHSS score 24 h after thrombolysis,and time to thrombolysis were important factors for predicting bleeding after thrombolysis(AUC=0.833,0.795,and 0.714,respectively,all P=0.000).Conclusions For patients with acute cerebral infarction,the risk of bleeding after thrombolysis is significantly increased i£the NIHSS score is unfavorable before thrombolysis or 24 h after thrombolysis,or the duration of acute cerebral infarction is long.Attention to risk factors and early intervention are warranted.
作者
李法良
陈龙
李静宇
Li Faliang;Chen Long;Li Jingyu(Department of Emergency»Henan Provincial People's Hospital yZhengzhou 450003,China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2022年第2期158-161,共4页
Chinese Journal of Geriatrics
