Abstract:

Objective To investigate the efficacy and safety of alteplase intravenous thrombolysis in the elderly patients with acute cerebral infarction (ACI), and the influencing factors for clinical prognosis. Methods This prospective study consecutively enrolled ACI patients treated with alteplase intravenous thrombolysis from Northern Jiangsu People's Hospital between September, 2016 and September, 2018. All patients were divided into the group aged ≥80 years old and the group aged <80 years old. The NIHSS score at admission and 24 hours after intravenous thrombolysis, 6-month mRS score and 6-month mortality of the two groups were compared. The complications related to thrombolytic therapy such as intracranial hemorrhage, and pulmonary infection were observed. Univariate and multivariate logistic regression analysis were used to determine the influencing factors for prognosis of all patients. Results Finally, a total of 119 patients were included, with a mean age of 70.12±10.55 years old (range: 46-94 years) and 69 (58.0%) males, 29 cases in the group aged ≥80 years old and 90 cases in the group aged <80 years old. The NIHSS score at admission for all patients ranged from 4 to 38. The NIHSS scores of the two groups at 24 hours after intravenous thrombolysis had no statistical difference, and both of them were significantly lower than that at admission (P <0.05). The incidence of intracranial hemorrhage, symptomatic intracranial hemorrhage, pulmonary infection, the percentage of patients with 6-month mRS score ≤2, and the 6-month mortality between the two groups all had no statistical difference. Multivariate logistic regression analysis showed that the door to needle time, NIHSS score at admission and pulmonary infection were independent risk factors for 6-month prognosis (all P <0.05), and higher age was not a factor affecting the prognosis (P >0.05) . Conclusions Alteplase intravenous thrombolytic therapy is safe and effective for ACI patients aged over 80 years, without increasing the risk of intracranial hemorrhage transformation, mortality and poor prognosis. The door to needle time, NIHSS score at admission and pulmonary infection were independent risk factors for 6-month prognosis in ACI patients treated with intravenous thrombolytic therapy.

Key words: Acute cerebral infarction; Intravenous thrombolysis; Alteplase; Prognosis

摘要：

目的 探讨高龄急性脑梗死患者接受阿替普酶静脉溶栓治疗有效性、安全性和临床预后的影响 因素。 方法 前瞻性连续纳入江苏省苏北人民医院2016年9月-2018年9月收治入院进行阿替普酶静脉溶 栓治疗的急性脑梗死患者，按照年龄将患者分为年龄≥80岁组和年龄＜80岁组。比较两组患者入院 时、溶栓24 h NIHSS评分，6个月mRS评分及死亡率，观察两组溶栓相关出血转化、症状性颅内出血及 肺部感染的发生情况。应用多因素Logistic回归分析观察所有患者静脉溶栓预后的独立影响因素。 结果 最终共纳入患者119例，男性69例（58.0%），年龄范围46～94岁，平均70.12±10.55岁，入院 NIHSS评分4～38分。其中年龄≥80岁患者29例，年龄＜80岁患者90例。静脉溶栓后，两组患者溶栓 24 h NIHSS评分较入院时均明显降低（均P＜0.05），两组治疗24 h NIHSS评分比较差异无统计学意义； 两组的出血转化、症状性颅内出血、肺部感染、6个月预后良好及死亡率比较，差异均无统计学意义。 多因素Logistic回归分析显示，入院到静脉溶栓时间、入院时NIHSS评分及肺部感染是脑梗死静脉溶 栓6个月预后的独立危险因素（P＜0.05），高龄不是影响预后的因素（P＞0.05）。 结论 高龄急性脑梗死患者静脉溶栓治疗安全有效，未增加颅内出血转化风险、死亡率及不良预 后。入院到静脉溶栓时间、入院时NIHSS评分及肺部感染是急性脑梗死患者静脉溶栓6个月预后不良 的独立危险因素。

关键词: 脑梗死; 静脉溶栓; 阿替普酶; 预后