阿替普酶静脉溶栓治疗发病4.5h内脑卒中患者出院后第90天临床结局的相关因素分析

doi:10.3969/j.issn.1006-6233.2024.11.030

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摘要 目的:分析阿替普酶(rt-PA)静脉溶栓治疗发病4.5h内脑卒中患者出院后第90天临床结局的相关因素。方法:选取2021年1月至2024年2月期间在本院行rt-PA静脉溶栓治疗的87例发病4.5h内脑卒中患者作为研究对象,依据第90天改良Rankin量表(mRS)评价结果分为结局不佳组(mRS>2分,n=31)和结局良好组(mRS≤2分,n=56)。单因素分析影响发病4.5h内脑卒中患者rt-PA静脉溶栓治疗出院后第90天临床结局不佳的影响因素,多因素Logistic回归分析导致发病4.5h内脑卒中患者rt-PA静脉溶栓治疗出院后第90天临床结局不佳的独立风险因素。结果:单因素分析显示,相较于结局良好组,结局不佳组从症状出现到静脉溶栓治疗时间(ONT)、到达医院到开始静脉溶栓治疗时间(DNT)更长,溶栓前美国国立卫生研究院卒中量表(NIHSS)评分更高,Alberta卒中项目早期CT(ASPECTS)评分更低,合并高血压和前循环梗死概率更高,脂蛋白(a)水平更高(P<0.05);多因素Logistic回归分析显示,ONT长(95%CI:1.030~1.195)、DNT长(95%CI:1.031~1.182)、溶栓前NIHSS评分高(95%CI:1.052~1.192)为导致发病4.5h内脑卒中患者rt-PA静脉溶栓治疗出院后第90天临床结局不佳的独立风险因素(P<0.05)。结论: ONT、DNT、溶栓前NIHSS评分等与发病4.5h内脑卒中患者rt-PA静脉溶栓治疗出院后第90天临床结局具显著相关性,且均为导致发病4.5h内脑卒中患者rt-PA静脉溶栓治疗出院后第90天临床结局不佳的独立风险因素。

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关键词 ：阿替普酶, 脑卒中, 静脉溶栓, 临床结局, 风险因素

Abstract：Objective: To analyze the related factors of clinical outcomes on the 90th day after discharge in patients with stroke treated by alteplase (rt-PA) intravenous thrombolysis within 4.5 hours of onset .Methods: From January 2021 to February 2024, 87 patients with stroke within 4.5 hours of onset who received rt-PA intravenous thrombolysis in the hospital were selected as the research subjects. According to the 90-day modified Rankin scale (mRS) evaluation results, they were divided into poor outcome group (mRS>2 points, n=31) and good outcome group (mRS≤2 points, n=56). Univariate analysis was used to analyze the influencing factor affecting the poor clinical outcomes on the 90th day after discharge. Multivariate Logistic regression analysis was applied to analyze the independent risk factors leading to the poor clinical outcomes.Results: Univariate analysis showed that compared with the good outcome group, the poor outcome group had longer onset to thrombolysis time (ONT) and admission to thrombolysis time (DNT), higher pre-thrombolysis National Institutes of Health Stroke Scale (NIHSS) score, lower early Alberta Stroke Project CT (ASPECTS) score, higher probabilities of hypertension and anterior circulation infarction and higher lipoprotein (a) level (P<0.05). Multivariate Logistic regression analysis found that long ONT (95%CI: 1.030-1.195), long DNT (95%CI: 1.031-1.182) and high NIHSS score before thrombolysis (95%CI: 1.052-1.192) were independent risk factors for poor clinical outcomes on the 90th day after discharge in stroke patients after the treatment of rt-PA intravenous thrombolysis within 4.5 hours of onset (P<0.05).Conclusion: ONT, DNT, and pre-thrombolysis NIHSS score are significantly correlated with the clinical outcomes on the 90th day after discharge in stroke patients within 4.5 hours of onset, and they are all independent risk factors for poor clinical outcomes on the 90th day after discharge.

Key words： Alteplase Stroke Intravenous thrombolysis Clinical outcomes Risk factors

基金资助:湖南省卫生健康委2020年度科研立项课题,(编号:20201928)

通讯作者: 云宗金

引用本文:

李波, 童洋萍, 云宗金. 阿替普酶静脉溶栓治疗发病4.5h内脑卒中患者出院后第90天临床结局的相关因素分析[J]. 河北医学, 2024, 30(11): 1913-1917.
LI Bo, et al. Related Factors of Clinical Outcomes on the 90th Day after Discharge in Patients with Stroke Treated by Intravenous Thrombolysis with Alteplase within 4.5 Hours of Onset. HeBei Med, 2024, 30(11): 1913-1917.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.11.030 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I11/1913

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