阿替普酶静脉溶栓治疗急性心源性缺血性脑卒中的预后影响因素分析

被引：23

作者：

沈芳 ^{[1
]}

沈红健 ^{[1
]}

邢鹏飞 ^{[1
]}

姜乐 ^{[1
]}

黄石仁 ^{[1
]}

张永巍 ^{[1
]}

吴涛 ^{[1
]}

邓本强 ^{[1
]}

机构：

[1] 海军军医大学(第二军医大学)长海医院脑血管病中心

来源：

海军军医大学学报 | 2018年 / 39卷 / 09期

关键词：

急性心源性缺血性脑卒中; 静脉溶栓疗法; 预后; 阿替普酶; 症状性颅内出血;

D O I：

10.16781/j.0258-879x.2018.09.1028

中图分类号：

R743.3 [急性脑血管疾病（中风）];

学科分类号：

1002 ;

摘要：

目的分析急性心源性缺血性脑卒中患者静脉溶栓治疗预后的影响因素。方法选择2013年9月至2017年9月在海军军医大学(第二军医大学)长海医院脑血管病中心接受阿替普酶静脉溶栓治疗的急性心源性缺血性脑卒中患者91例。以静脉溶栓后3个月改良Rankin量表(m RS)评分作为预后评价指标,m RS评分≤2分的患者纳入预后良好组(54例),3~6分者纳入预后不良组(37例)。分析两组患者的年龄、性别、既往史、基线美国国立卫生研究院卒中量表(NIHSS)评分、基线格拉斯哥昏迷量表(GCS)评分、溶栓前Alberta脑卒中早期计算机断层扫描评分(ASPECTS)等指标,并采用多因素logistic回归分析急性心源性缺血性脑卒中患者阿替普酶静脉溶栓治疗预后的影响因素。结果静脉溶栓后3个月预后良好率为59.3%(54/91),预后良好组和预后不良组患者的年龄[(66.57±13.46)岁vs(75.95±6.06)岁]、卵圆孔未闭患者比例[11.1%(6/54)vs 0.0%(0/37)]、基线NIHSS评分[7.5(3.5,13.0)分vs 18.0(13.0,22.0)分]、基线GCS评分[14.5(12.0,15.0)分vs 10.0(8.0,14.0)分]、溶栓前ASPECTS[10.0(9.0,10.0)分vs 9.0(8.0,10.0)分]、症状性颅内出血(SICH)发生率[1.9%(1/54)vs 32.4%(12/37)]差异均有统计学意义(t=3.964,χ~2=4.401,Z=5.235,Z=4.079,Z=2.519,χ~2=16.768;P均<0.05)。多因素logistic回归分析表明年龄[比值比(OR)=3.236,95%置信区间(CI):1.077~9.709,P=0.036]、基线NIHSS评分(OR=2.874,95%CI:1.074~6.329,P=0.034)、SICH(OR=9.346,95%CI:1.017~83.333,P=0.048)是急性心源性缺血性脑卒中静脉溶栓治疗患者预后不良的独立预测因素。结论年龄、脑卒中严重程度和SICH是影响急性心源性缺血性脑卒中静脉溶栓患者预后不良的独立预测因素。阿替普酶静脉溶栓治疗急性心源性缺血性脑卒中患者的年龄越大、脑卒中严重程度越重或发生SICH,预后越差。

引用

页码：1028 / 1033

页数：6

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