脑梗死后认知功能障碍与rt-PA静脉溶栓相关性的临床研究

发布时间：2018-06-06 04:50

本文选题：急性脑梗死 + 静脉溶栓　；参考：《浙江大学》2013年硕士论文

【摘要】：目的观察rt-PA静脉溶栓后急性脑梗死患者3个月末的认知功能,分析脑梗死后血管性认知功能损害与rt-PA静脉溶栓的相关性。方法前瞻性观察金华市中医院神经内科连续收集的首发急性脑梗死患者,根据是否接受rt-PA静脉溶栓治疗分为溶栓组和非溶栓组(对照组)。比较两组间年龄、性别、重要部位梗死(额叶、颞叶、丘脑、基底节)、教育程度、高血压史、房颤史、收缩压、舒张压、C反应蛋白、代谢障碍情况(糖尿病史、高血脂史、空腹血糖、空腹低密度脂蛋白)等基线因素,动态观察两组间入院24小时内及3个月末的认知功能,采用MMSE、MoCA评分,应用SPSS统计软件,单因素及多因素logistic回归分析认知功能与rt-PA静脉溶栓的相关性。结果 43例患者纳入本次研究,其中溶栓组为21例,对照组22例。单因素分析结果显示：溶栓组与对照组上述基线数据无统计学差异；3个月末溶栓组与对照组MoCA(P0.05, P=0.036)、MMSE (P0.05, P=0.029)评分均有差异。 3个月末使用MMSE量表测定认知功能：单因素分析显示高血压史、年龄、C反应蛋白、rt-PA静脉溶栓、重要部位梗死、教育程度是影响认知功能的重要因素(P0.05)。多因素分析显示年龄(OR0.674,95%CI0.410-0.887, P=0.048)、梗死部位(OR0.355,95%CI0.127-0.536, P=0.037)是血管性认知功能损害的独立危险因子。而rt-PA静脉溶栓(OR1.521,95%CI1.304-1.780, P=0.041)是血管性认知功能损害的独立保护因子。 3个月末使用MoCA量表测定认知功能：单因素分析显示年龄、rt-PA静脉溶栓、重要部位梗死、教育程度是影响认知功能的重要因素(P0.05)。多因素分析显示年龄(OR0.536,95%CI0.357-0.763, P=0.040)、重要部位梗死(OR0.262,95%CI0.065-0.574, P=0.026)是血管性认知功能损害的独立危险因子,而rt-PA静脉溶栓(OR1.701,95%CI1.461-1.975, P=0.033)、教育程度(OR1.361,95%CI1.108-1.635, P=0.042)是血管性认知功能损害的独立保护因子。结论 rt-PA静脉溶栓对脑梗死后患者认知功能有影响,rt-PA静脉溶栓是影响脑梗死患者3个月末认知功能的独立保护因子。
[Abstract]:Purpose To observe the cognitive function of patients with acute cerebral infarction after rt-PA intravenous thrombolysis for 3 months, and to analyze the correlation between vascular cognitive impairment and venous thrombolysis of rt-PA after cerebral infarction. Method The first acute cerebral infarction patients collected continuously from Department of Neurology of Jinhua traditional Chinese Medicine Hospital were prospectively observed and divided into thrombolytic group and non-thrombolytic group according to whether they received rt-PA intravenous thrombolytic therapy (control group). Age, sex, important site infarction (frontal lobe, temporal lobe, thalamus, basal ganglia, education, history of hypertension, history of atrial fibrillation, systolic blood pressure, diastolic pressure, C-reactive protein, metabolic disorder (history of diabetes, history of hyperlipidemia) were compared between the two groups. Baseline factors such as fasting blood glucose and fasting low density lipoprotein) were used to dynamically observe cognitive function of the two groups within 24 hours of admission and 3 months after admission. MMSE MoCA score and SPSS statistical software were used. Univariate and multivariate logistic regression analysis showed the correlation between cognitive function and intravenous thrombolysis in rt-PA. Result 43 patients were included in the study, including 21 patients in thrombolysis group and 22 patients in control group. The results of univariate analysis showed that there was no significant difference in baseline data between the thrombolytic group and the control group, and the scores of MoCAG P0.05, P0.036 MMSE P0.05, P0.029) in the thrombolytic group and the control group at the end of 3 months were significantly different. At the end of 3 months, MMSE scale was used to measure cognitive function: univariate analysis showed that hypertension history, age C reactive protein rt-PA thrombolytic therapy, important site infarction, and education level were important factors affecting cognitive function (P 0.05). Multivariate analysis showed that the age of OR 0.674 / 95 and CI _ (0.410-0.887), P _ (0.048), O _ (0.355-95) CI _ (0.127-0.536), P _ (0.037) were independent risk factors for vascular cognitive impairment. The CI 1.304-1.780, Pu 0.041 were independent protective factors for vascular cognitive impairment in rt-PA intravenous thrombolytic therapy (OR 1.521 ~ 95, CI = 1.304-1.780, P = 0.041). At the end of 3 months, MoCA scale was used to measure cognitive function: univariate analysis showed that age patients with rt-PA thrombolytic therapy, important site infarction, and education level were the important factors affecting cognitive function (P 0.05). Multivariate analysis showed that the age of OR0.536-95CI0.357-0.763, P0. 040, important site infarction OR0. 262 ~ 95 CI0.065-0.574, P0. 026) were independent risk factors of vascular cognitive impairment, while rt-PA intravenous thrombolytic thrombolysis OR1. 70195CI1. 461-1.975, P0.033, educational level OR1. 361, 95CI1. 108-1.635, P0. 042) were independent protective factors of vascular cognitive impairment. Conclusion The effect of rt-PA intravenous thrombolytic therapy on cognitive function of patients with cerebral infarction is that rt-PA intravenous thrombolysis is an independent protective factor affecting cognitive function of patients with cerebral infarction at the end of 3 months.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R743.3;R749.1

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