心源性卒中重组组织型纤溶酶原激活剂静脉溶栓治疗的疗效观察

发布时间：2018-08-06 20:49

【摘要】：目的:观察心源性卒中患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的疗效。方法:前瞻性收集发病4.5h内接受rt-PA静脉溶栓治疗的急性缺血性卒中患者,根据TOAST分型标准,将所有患者分为心源性卒中组、非心源性卒中组两组,比较两组患者早期疗效、远期预后以及症状性颅内出血(slCH)发生率、死亡率。结果:共94例患者纳入研究,其中心源性卒中组33例,非心源性卒中组61例,心源性卒中组患者当前吸烟比例低于非心源性卒中组[9.1%(3/33)与36.1%(22/61),χ2=7.892,P=0.005],心源性卒中组心房颤动比例明显高于非心源性卒中组[72.7%(24/33)与4.9%(3/61),χ2=48.096,P0.001],入院时NIHSS评分等其他基线资料比较差异无统计学意义。两组溶栓后24h、出院时NIHSS评分及NIHSS评分下降程度比较差异有统计学意义(P0.05);心源性卒中组出院时神经功能改善率低于非心源性卒中组,差异有统计学意义(P0.05);心源性卒中组远期预后良好率低于非心源性卒中组[24.2%(8/33)与47.5%(29/61),χ2=4.870,P=0.027],心源性卒中组slCH发生率、死亡率均高于非心源性卒中组,分别为[18.2%(6/33)与4.9%(3/61),χ2=4.352,P=0.037]、[18.2%(6/33)与6.6%(4/61),χ2=4.451,P=0.035],多因素回归分析显示,在校正年龄、血糖、溶栓前24h抗血小板或抗凝、当前吸烟、房颤、基线NIHSS评分的因素后,心源性卒中组s ICH发生风险约是非心源性卒中组的5倍(OR:5.12;95%CI:0.13-21.45;P=0.039);死亡风险约是非心源性卒中的3倍(OR:2.98;95%CI:0.74-12.76 P=0.048);出院时神经功能改善率与90天预后良好率显著低于非心源性卒中组,分别为(OR:0.41;95%CI:0.13-1.02;P=0.045)、(OR:0.36;95%CI:0.14-0.93;P=0.031)。结论:心源性卒中rt-PA静脉溶栓治疗早期疗效及远期预后较非心源性卒中差,slCH发生率及死亡率高于非心源性卒中,因此,应积极预防心源性卒中的发生。
[Abstract]:Objective: to observe the effect of intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) in patients with cardiogenic stroke. Methods: patients with acute ischemic stroke received intravenous thrombolytic therapy with rt-PA within 4.5 hours after onset were prospectively collected. According to the criteria of TOAST classification, all patients were divided into two groups: cardiogenic stroke group and non-cardiogenic stroke group. The early curative effects of the two groups were compared. Long-term prognosis, (slCH) incidence and mortality of symptomatic intracranial hemorrhage. Results: a total of 94 patients were included in the study, including 33 patients with cardiogenic stroke and 61 patients with non-cardiogenic stroke. The prevalence of smoking in cardiogenic stroke group was significantly lower than that in non-cardiogenic stroke group [9.1% (3 / 33) vs 36.1% (22 / 61), 蠂 ~ 2 = 7.892 P0. 005]. The rate of atrial fibrillation in cardiogenic stroke group was significantly higher than that in non-cardiogenic stroke group [72.7% (24 / 33) vs 4.9% (3 / 61), 蠂 ~ 2 / 48.096 P0.001]. There was no significant difference in other baseline data such as NIHSS score at admission. At 24 hours after thrombolysis, there was a significant difference in NIHSS score and NIHSS score between the two groups (P0.05), and the improvement rate of neurological function in cardiogenic stroke group was lower than that in non-cardiogenic stroke group at discharge (P0.05). The long-term good prognosis rate in cardiogenic stroke group was significantly lower than that in non-cardiogenic stroke group [24.2% (8 / 33) vs 47.5% (29 / 61), 蠂 ~ 2 + 4.870 P 0.027]. The incidence of slCH in cardiogenic stroke group was higher than that in non-cardiogenic stroke group, which was [18.2% (6r33) and 4.9% (361), 蠂 ~ 2 4.352P ~ (0.037)], [18.2% (6r / 33) and 6.6% (461), 蠂 ~ (2 / 451) P ~ (0.035)]. After adjusting for age, blood glucose, anti-platelet or anticoagulant factors 24 hours before thrombolysis, current smoking, atrial fibrillation, baseline NIHSS score, The risk of ICH in cardiogenic stroke group was about 5 times as high as that in non-cardiogenic stroke group (OR: 5.1295CI0.13-21.45P0.039), and the risk of death was about three times higher than that in non-cardiogenic stroke group (OR: 2.98 ~ 95CIW 0.74-12.76 P0.048). The neurologic function improvement rate and the good prognosis rate at 90 days after discharge were significantly lower than those in non-cardiogenic stroke group (ORO: 0.4195CIW 0.13-1.02Cw 0.13-1.02P0.045), (order weight 0.3695CIo 0.14-0.93P0.031). Conclusion: the early curative effect and long-term prognosis of rt-PA in cardiogenic stroke are higher than that in non-cardiogenic stroke. Therefore, it is necessary to prevent the occurrence of cardiogenic stroke.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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