摘要
目的研究急性前循环梗死合并中重度脑白质疏松患者超早期静脉应用重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)静脉溶栓治疗的预后及相关因素,为患者的临床诊断及预后评估提供指导。方法回顾性分析2015年1月-2018年6月上海市第一人民医院宝山分院接诊的88例急性前循环梗死患者。按照治疗方法的不同,将所有患者分为研究组与对照组,研究组48例给予rt-PA溶栓治疗。对照组36例患者未给予溶栓处理。观察对比两组患者的肢体运动功能、神经功能、脑白质疏松情况、梗死面积以及预后情况。结果研究组患者基线NIHSS评分(National Institute of Health stroke scale)、24 h NIHSS评分、7 d NIHSS评分明显高于对照组患者,差异有统计学意义。两组患者入院FMS评分(Functional Movement Screen)无明显差异。研究组患者的90 d FMS评分明显低于对照组患者。logistic回归分析结果提示,中重度脑白质疏松是影响静脉溶栓患者90 d预后的危险因素(OR=4.565 2,95%CI=1.200 1~67.725 1,P=0.032 7)。结论急性前循环梗死合并中重度脑白质疏松患者给予rt-PA静脉溶栓治疗后出血转化发生率提高,中重度脑白质疏松可作为预后不良的独立因素。
OBJECTIVE To study the prognosis and related factors of rt-PA intravenous thrombolysis in patients with acute anterior circula. tion infarction combined with moderate to severe leukoaraiosis. METHODS A retrospective analysis were made of 88 patients with acute anterior circulation infarction treated in target hospital from January 2015 to June 2018. According to the different treatment methods,all patients were divided into study group and control group. 48 patients in the study group were treated with rt-PA thrombolysis. 36 patients in the control group were not treated with thrombolysis. The limb motor function,nerve function,leukoaraiosis,infarct size and progno. sis were observed and compared between these two groups. The patients'leukoaraiosis and infarct size were also studied. RESULTS The baseline NIHSS score,24h NIHSS score and 7d NIHSS score of the study group were significantly higher than the control group. There were no significant difference in admission FMS score between these two groups. The 90-day FMS score of the study group were signifi. cantly lower than the control group. Logistic regression analysis showed that moderate to severe leukoaraiosis(OR=4.565 2, 95% CI 1.200 1,67.725 1,P=0.032 7)was a risk factor for 90-day prognosis in patients with intravenous thrombolysis. CONCLUSION The inci. dence of hemorrhagic transformation in patients with acute anterior circulation infarction combined with moderate to severe leukoaraiosis was increased after rt-PA intravenous thrombolysis,moderate to severe leukoaraiosis might be an independent prognostic factor.
作者
吕艳
汪丽韡
黄澄
陈永烨
李胜玲
Lü Yan;WANG Li-wei;HUANG Cheng(Baoshan Branch,Shanghai First People’s Hospital,Shanghai,200940,China)
出处
《中国初级卫生保健》
2019年第7期101-103,共3页
Chinese Primary Health Care
关键词
急性前循环梗死
中重度脑白质疏松
静脉溶栓治疗
预后
acute anterior circulation infarction
moderate to severe leukoaraiosis
intravenous thrombolytic therapy
prognosis
