摘要
目的探讨不同NIHSS分级的急性缺血性脑卒中静脉溶栓后2 h效果与溶栓后24 h效果关联性,了解溶栓后2 h效果是否可以用作动脉溶栓及介入手术条件和预后判定。方法选择2017年10月—2018年12月本院收治的急性缺血性脑卒中患者136例作为研究对象,按溶栓前NIHSS评分高低分为轻度卒中/小卒中组(42例)、中度卒中组(70例)、中-重度卒中组(17例)、重度卒中组(7例)四组。根据中国急性缺血性脑卒中静脉溶栓指导规范(2016年),发病至溶栓4.5 h内使用阿替普酶溶栓,4.5~6 h使用尿激酶溶栓,分别在治疗后2 h、24 h对患者效果进行评估,比较溶栓后2 h与24 h NIHSS评分、治疗预后[改良Rankin量表(mRS)评分]。结果(1)轻度卒中静脉溶栓2 h后NIHSS评分降低患者有96.15%24 h后仍保持降低。轻度卒中静脉溶栓2 h后NIHSS评分增加患者在24 h后100%仍无好转。轻度卒中静脉溶栓2小时后NIHSS评分无变化患者66.67%在24 h后将降低,8.33%病情将加重,25%保持无变化。(2)中度卒中静脉溶栓2 h后NIHSS评分降低患者中89.66%在24 h后仍保持降低,而有10.34%加重。中度卒中静脉溶栓2 h后NIHSS评分增加的患者100%在24 h后仍无好转。中度卒中静脉溶栓2 h后NIHSS评分无变化患者仅26.47%在24 h后将好转,17.65%将加重,55.89%保持无变化。(3)中-重度卒中静脉溶栓2 h时后NIHSS评分降低的患者50%在24 h后仍保持降低,而50%几率无好转。中-重度卒中静脉溶栓2 h后NIHSS评分增加的患者100%在24 h后仍旧增加。中-重度卒中静脉溶栓2 h后NIHSS评分无变化患者18.18%在24 h后将降低,9.09%将加重,72.73%保持无变化。(4)重度卒中静脉溶栓2 h后NIHSS评分有好转患者100%在24 h后仍保持好转,重度卒中静脉溶栓2 h后NIHSS评分增加患者100%在24 h后仍无好转,重度卒中静脉溶栓2 h后NIHSS评分无变化患者100%在24 h后保持无变化。结论根据对不同NIHSS评分缺血性脑卒中患者进行分级,观察静脉溶栓后2 h效果即可推断其溶栓后24 h效果,并作为进行急诊动脉溶栓及介入手术的依据。
Objective To investigate the correlation between the effect of thrombolysis after intravenous thrombolysis for 2h and 24 for the patients suffering acute ischemic stroke with different NIHSS,and to understand whether the effect of thrombolysis after thrombolysis for 2h can be used as evidence for arterial thrombolysis and interventional conditions and prognosis.Methods A total of 136 patients with acute ischemic stroke who were treated in our hospital between October 2017 and December 2018 were enrolled in this study.According to the level of NIHSS before thrombolysis,they were divided into four groups.There were 42 cases in the mild stroke group,70 cases in the moderate stroke group,17 cases in the moderate-to-severe stroke group,and 7 cases with severe stroke.According to the guidelines for intravenous thrombolysis in acute ischemic stroke in China(2016),rt-PA was used within 4.5 hours for thrombolysis,and Urokinase was used between 4.5 and 6 hours.At 2ndh and 24thh after treatment,the NIHSS score and the treatment prognosis(modified Rankin scale(mRS)score)of the patients was evaluated.Results After 2 hours of intravenous thrombolysis,96.15%of the NIHSS score of the patients with decreased scores in mild stroke group continue to decrease after 24 hours.The patients in mild stroke group with an increase of NIHSS score after intravenous thrombolysis for 2h did not improve after 24 hours.In mild stroke group,66.67%of the patients those who without an increase in NIHSS score 2h after thrombolysis presented a decrease of NIHSS score after 24 hours,and 8.33%of them getting worse and 25%without any change.Conclusions the NIHSS score increased and the patient patients with no change in NIHSS score after 2 hours of mild stroke intravenous thrombolysis will decrease after 24 h,8.33%will be aggravated,and 25%will remain unchanged;2.In patients with moderate NIHSS scores after 2 hours of moderate thrombolysis,89.66%remained lower after 24 hours,while 10.34%was aggravated.After 2 hours of moderate stroke intravenous thrombolysis,100%of patients with an increased NIHSS score did not improve after 24 hours.Only 26.47%of patients with no change in NIHSS score after 2 hours of moderate stroke intravenous thrombolysis will improve after 24 hours,17.65%will be aggravated,and 55.89%will remain unchanged;3.After 2 hours of intravenous thrombolysis in moderate-to-severe stroke,50%of patients with reduced NIHSS scores remained reduced after 24 hours.And the 50%chance is not improved.100%of patients with an increased NIHSS score 2 hours after moderate to severe stroke intravenous thrombolysis continued to increase after 24 hours.After 1 hour of moderate-to-severe stroke intravenous thrombolysis,18.18%of patients with no change in NIHSS score will decrease after 24 hours,9.09%will be aggravated,and 72.73%will remain unchanged;4.Patients with a decrease in NIHSS score after 2 hours of severe thrombolysis were still reduced after 24 hours.After 2 hours of severe stroke intravenous thrombolysis,100%of patients with increased NIHSS score did not improve after 24 hours.After 2 hours of intravenous thrombolysis with severe stroke,100%of patients with no change in NIHSS score remained unchanged after 24 hours;Conclusions According to the classification of patients with different NIHSS scores of ischemic stroke,the effect of 2 hours after intravenous thrombolysis can be predicted to predict the effect of thrombolysis 24 hours after thrombolysis,and as evidence for emergency arterial thrombolysis and interventional surgery.
作者
吴国新
冯垣波
刘之钰
吴智鑫
叶镱
蔡阳林
何家成
关紫云
WU Guo-xin(Department of emergency,people's hospital of Nanhai district,Foshan,Guangdong,528200,China.)
出处
《齐齐哈尔医学院学报》
2019年第21期2660-2663,共4页
Journal of Qiqihar Medical University
基金
佛山市科技局科技创新项目(2017AG100082、2017AG100061、FS0AA-KJ218-1301-0015)
广东省医学科学技术研究基金项目(A2019185)
佛山市十三五特色专科建设项目(FSTSZK010)
关键词
静脉溶栓
急性缺血性脑卒中
NIHSS评分
溶栓后2
H
溶栓后24
H
关联性
Intravenous thrombolysis
Acute ischemic stroke
NIHSS score
2 hours after thrombolysis
24 hours after thrombolysis
Association
