阿替普酶静脉溶栓治疗急性后循环缺血性卒中患者的预后相关因素分析

doi:10.3969/j.issn.1673-5765.2017.02.004

摘要/Abstract

摘要：

目的探讨分析影响阿替普酶静脉溶栓治疗急性后循环缺血性卒中患者的预后的相关因素。方法选取发病0～4.5 h急性后循环缺血性卒中患者，分为阿替普酶静脉溶栓组和非静脉溶栓组，记录患者的一般人口学资料及基本资料、美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分，溶栓组记录发病至溶栓时间及溶栓后24 h NIHSS评分下降。结局指标采用90 d改良Rankin量表（modified Rankin Scale，mRS）评分、症状性颅内出血（symptomatic intracranial hemorrhage，SICH）及患者死亡率，应用Logistic回归模型分析卒中患者90 d不良结局的相关因素。结果急性后循环缺血性卒中患者共116例，其中成功给予阿替普酶静脉溶栓治疗的患者84例，非静脉溶栓32例。静脉溶栓组3个月预后良好53例（63.1%），预后不良31例（36.9％），其中发生出血转化6例（7.1%），症状性颅内出血3例（3.5%），死亡3例（3.5%）。非静脉溶栓组3个月预后良好12 例（37.5％），预后不良20例（62.5％），其中发生出血转化5例（15.6%），症状性颅内出血3例（9.3%），死亡3例（9.3%）。静脉溶栓组经多因素Logistic回归分析显示，年龄、发病至溶栓时间、基线NIHSS评分、高血压与90 d不良预后相关（P＜0.05）。静脉溶栓组和非静脉溶栓组相比，静脉溶栓组有更好的临床预后及更低的死亡率，两组在症状性颅内出血发病率方面并无明显差异。结论对于急性后循环缺血性卒中患者，尽早实施静脉溶栓对改善近期预后有一定临床意义。

文章导读： 本研究结果显示阿替普酶静脉溶栓治疗急性后循环缺血性卒中患者积极有效，可改善患者的临床
预后。

关键词: 急性缺血性卒中; 后循环缺血; 静脉溶栓; 预后

Abstract:

Objective To investigate the correlation factors for the prognosis in patients with posterior circulation infarction after intravenous thrombolysis with alteplase. Methods The patients with posterior circulation infarction at 0-4.5 h after onset were selected and divided into alteplase intravenous thrombolysis group and non-intravenous thrombolysis group. General demographic data and basic information were recorded and evaluated with National Institutes of Health Stroke Scale (NIHSS) score. The time from onset to thrombolysis and NIHSS score at 24 h after thrombolysis were also recorded. The outcome indexes included 90-day functional outcomes (by modified Rankin Scale, mRS), symptomatic intracranial hemorrhage (SICH) and mortality. Logistic regression analysis was used to evaluate the indexes in predicting the 3-month outcome of patients. Results A total of 116 patients with acute posterior circulation infarction were included. Among which, 84 (72.4%) were in intravenous thrombolysis group and 32 were in non-thrombolysis group. There were 53 cases (63.1%) in good prognosis group and 31 cases (36.9%) in poor prognosis group. Whereby, there were 6 cases of hemorrhage transformation (7.1%), and 3 cases of symptomatic intracranial hemorrhage (3.5%). In non-intravenous thrombolysis group, there were 12 cases of good prognosis at month 3 (37.5%) and 20 cases of poor prognosis (62.5%). Whereby, there were 5 cases of hemorrhage transformation (15.6%), 3 cases of symptomatic intracranial hemorrhage (9.3%) and 3 cases of deaths (9.3%). Logistic regression analysis showed that the age, thrombolysis time and the NIHSS score, hypertension were the associated with the poor prognosis of posterior circulation infarction patients after intravenous thrombolysis at 90 d (P <0.05). Compared with non-intravenous thrombolysis group, patients in intravenous thrombolysis group had a significant improvement of favorable outcome and lower mortality, however, there was no significant difference in morbidity of SICH between the two groups. Conclusion Early intravenous thrombolysis has certain significant influence on improving the short-term prognosis in patients with posterior circulation infarction.

Key words: Ischemic stroke; Posterior circulation infarction; Thrombolytic therapy; Prognosis

车锋丽，陈胜云，赵性泉，杜会山，魏建朝. 阿替普酶静脉溶栓治疗急性后循环缺血性卒中患者的预后相关因素分析[J]. 中国卒中杂志, 2017, 12(02): 112-118.

CHE Feng-Li, CHEN Sheng-Yun, ZHAO Xing-Quan, et al.. Correlation Factors Analysis for the Prognosis in Patients with Posterior Circulation Infarction after Intravenous Thrombolysis with Alteplase[J]. Chinese Journal of Stroke, 2017, 12(02): 112-118.

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