阿替普酶静脉溶栓治疗的急性缺血性卒中患者早期神经功能恶化的影响因素

发布时间：2018-03-25 10:30

本文选题：缺血性卒中　切入点：阿替普酶　出处：《华北理工大学》2017年硕士论文

【摘要】：目的近年来,脑血管疾病已跃居城市第二位、农村第一位死亡原因,其中急性缺血性脑卒中致残、致死率极高,严重威胁患者生命健康,为个人乃至社会带去沉重的生活、经济负担。阿替普酶(rt-PA)作为一种重组组织型纤溶酶原激活剂,是目前世界上唯一被批准并推荐用于治疗急性缺血性脑卒中的一线药物,然而相当一部分患者并未从溶栓治疗中获益,发生早期神经功能恶化(Early Neurological Deterioration,END),病情进一步发展。本研究旨在探讨阿替普酶静脉溶栓治疗的急性缺血性卒中患者发生早期神经功能恶化的危险因素。方法本研究回顾性分析自2006年1月至2015年5月连续登记的发病4.5小时内给予阿替普酶静脉溶栓治疗的急性缺血性卒中患者,按照溶栓后是否发生早期神经功能恶化(早期神经功能恶化定义为:溶栓后24小时内NIHSS评分较基线增加≥4分或死亡)分为恶化组(END组)和非恶化组(n END组)。危险因素分析采用多因素Logistic回归模型计算比值比(OR值)及其95%置信区间(95%CI)。结果本研究共纳入220例发病4.5小时内给予阿替普酶静脉溶栓治疗的急性缺血性卒中患者,其中34例(15.5%)经阿替普酶静脉溶栓治疗后24小时内发生早期神经功能恶化。经多因素Logistic回归分析显示:年龄(每增加10岁:OR=1.963,95%CI=1.067-3.614)、入院血糖(每增加1mmol/L:OR=1.409,95%CI=1.191-1.667)、白细胞计数(每增加1×109/L:OR=1.197,95%CI=1.018-1.409)、基线NIHSS评分(每增加1分:OR=1.267,95%CI=1.091-1.475)、吞咽障碍(OR=4.312,95%CI=1.131-16.435)、昏迷(OR=22.314,95%CI=1.385-359.505)、责任大血管闭塞(OR=11.739,95%CI=2.600-52.999)和TOAST分型中的心源性脑栓塞(OR=3.671,95%CI=1.090-12.367)与阿替普酶静脉溶栓后发生早期神经功能恶化显著相关(P0.05),为其独立影响因素。结论本研究结果显示:高龄、较高的入院随机血糖水平、白细胞计数及基线NIHSS评分、吞咽障碍、昏迷、责任大血管闭塞及TOAST分型为心源性脑栓塞类型的患者发病4.5小时内给予阿替普酶静脉溶栓治疗后更容易发生早期神经功能恶化。对于这些患者,临床医生应该加强溶栓前的沟通,慎重使用阿替普酶静脉溶栓,溶栓后需密切观察病情变化,必要时尽早进行桥接血管内治疗。
[Abstract]:Objective in recent years, cerebrovascular diseases have become the second most important cause of death in urban areas and the first cause of death in rural areas. Among them, acute ischemic stroke causes disability, resulting in a very high mortality rate, which seriously threatens the life and health of patients and brings a heavy life to individuals and society. As a recombinant tissue type plasminogen activator, Atip rt-PAA is the only first-line drug approved and recommended for the treatment of acute ischemic stroke in the world. However, a significant number of patients did not benefit from thrombolytic therapy, The purpose of this study was to investigate the risk factors of early neurological deterioration in patients with acute ischemic stroke treated by intravenous thrombolytic therapy with atropine. Methods the purpose of this study was to investigate the risk factors of early neurological deterioration in patients with acute ischemic stroke treated by intravenous thrombolytic therapy. An analysis of patients with acute ischemic stroke who received intravenous thrombolytic therapy with atropine within 4.5 hours of consecutive onset from January 2006 to May 2015, According to whether early nerve function deterioration occurred after thrombolysis (defined as: the NIHSS score increased more than 4 points or died from baseline within 24 hours after thrombolysis), the patients were divided into two groups: end group and END group. Multivariate Logistic regression model was used to calculate odds ratio (OR) and 95% confidence interval (95% CI). Results 220 patients with acute ischemic stroke who received intravenous thrombolytic therapy with atropine within 4.5 hours after onset of the disease were included in this study. Early neurological deterioration occurred within 24 hours after intravenous thrombolytic therapy with atropase in 34 patients. Multivariate Logistic regression analysis showed that age (1.96395 CI 1.067-3.614), blood glucose (1.40995CI1.191-1.667U per 1 mmol / L), leukocyte count (per increase of 10 years). Add 1 脳 10 9 / L OR 1.197 95 CI 1.018-1.409, baseline NIHSS score (1.26795 CI 1.091-1.475m / 1), dysphagia 4.31295CI1.131-16.43535, coma OR22.31495CI1.385-359.505, OR11.73995CI2.600-52.999 and TOAST type 3.67195CI1.090-12.367a). Conclusion the results of this study show that the elderly, High admission random blood glucose level, white blood cell count and baseline NIHSS score, dysphagia, coma, Patients with responsible macrovascular occlusion and TOAST classification as cardiogenic cerebral embolism were more likely to develop early neurological deterioration after intravenous thrombolytic therapy with atropine within 4.5 hours of onset. The clinicians should strengthen the communication before thrombolytic therapy and carefully use atropase in intravenous thrombolytic therapy. After thrombolytic therapy, we should closely observe the state of the disease, and carry out bridging intravascular therapy as soon as necessary.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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