急性缺血性卒中静脉溶栓治疗的疗效及预后相关因素分析

耿介立; 宋叶平; 金海峰; 陈莺; 林　岩; 孙亚蒙; 潘元美; 俞　羚; 施国文; 徐　群

doi:10.12022/jnnr.2016-0032

神经病学与神经康复学杂志 ›› 2016, Vol. 12 ›› Issue (3) : 123-130. DOI: 10.12022/jnnr.2016-0032

原创研究

急性缺血性卒中静脉溶栓治疗的疗效及预后相关因素分析

耿介立，宋叶平，金海峰，陈莺，林　岩，孙亚蒙，潘元美，俞　羚，施国文，徐　群

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Effectiveness and prognosis-related factors of intravenous thrombolysis in patients with acute ischemic stroke

GENG Jieli, SONG Yeping, JIN Haifeng, CHEN Ying, LIN Yan, SUN Yameng, PAN Yuanmei, YU Ling, SHI Guowen, XU Qun

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文章历史 +

摘要

目的：静脉溶栓治疗是急性缺血性卒中最有效的治疗方法。本研究旨在探讨在现行卒中指南的指导下，静脉溶栓治疗的早期疗效和远期预后，以期为提高静脉溶栓治疗的获益提供临床证据。方法：记录136例接受重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator，rt-PA）静脉溶栓治疗的急性缺血性卒中患者的人口统计学特征、血管危险因素和本次卒中发生的情况。采用美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）对静脉溶栓治疗的早期疗效进行评价，改良Rankin量表（modified Rankin scale，mRS）对卒中发生后3个月时的功能独立情况进行评价。采用单因素和多因素分析对静脉溶栓治疗的早期疗效和卒中发生后3个月时功能独立的相关影响因素进行分析。结果：静脉溶栓治疗后24 h时，早期有效66例（48.5%）；卒中发生后3个月时，64例（47.1%）达功能独立。静脉溶栓治疗后2 h、24 h和7 d的早期疗效与卒中发生后3个月时的功能独立显著相关（P值均＜0.05）。静脉溶栓治疗前收缩压是静脉溶栓治疗早期疗效的独立影响因素（P＜0.05）。结论：降低静脉溶栓治疗前收缩压可能改善溶栓治疗的早期疗效。依据溶栓治疗的早期疗效，可能判断溶栓治疗的远期预后。

Abstract

Objective: Intravenous thrombolysis is the most effective therapy that guidelines have recommended for treating acute ischemic stroke. This study aims to evaluate the factors related to the clinical outcomes in patients with acute ischemic stroke receiving intravenous thrombolysis. Methods: This study recruited 136 patients with acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator (rt-PA). The demography, vascular risk factors and the characteristics of acute ischemic stroke were recorded. The early improvement which was defined as complete resolution of the neurologic deficit or an improvement from baseline in the score on the National Institute of Health Stroke Scale (NIHSS) 24 hours after intravenous thrombolysis and the independent functional outcomes which was defined as a score of 0 or 1 on the modified Rankin scale (mRS) three months after the onset of stroke were evaluated. The factors related to early improvement and late independent functional outcomes were examined by univariate and multivariate analyses. Results: Sixty-six patients (48.5%) achieved early improvement and 64 patients (47.1%) achieved late independent functional outcomes. The early efficacy 2 hours, 24 hours and 7 days after intravenous thrombolysis had relevance to the later prognosis (all P < 0.05). Lower systolic pressure was independently associated with better early improvement (P < 0.05). Conclusion: Decrease in systolic blood pressure before intravenous thrombolysis may promote the early improvement in patients with acute ischemic stroke. The early response to intravenous thrombolysis may predict the late outcomes.

导出引用

耿介立，宋叶平，金海峰，陈莺，林　岩，孙亚蒙，潘元美，俞　羚，施国文，徐　群. 急性缺血性卒中静脉溶栓治疗的疗效及预后相关因素分析[J]. 神经病学与神经康复学杂志. 2016, 12(3): 123-130 https://doi.org/10.12022/jnnr.2016-0032

GENG Jieli, SONG Yeping, JIN Haifeng, CHEN Ying, LIN Yan, SUN Yameng, PAN Yuanmei, YU Ling, SHI Guowen, XU Qun. Effectiveness and prognosis-related factors of intravenous thrombolysis in patients with acute ischemic stroke[J]. Journal of Neurology and Neurorehabilitation. 2016, 12(3): 123-130 https://doi.org/10.12022/jnnr.2016-0032

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