| 摘要: |
| 目的 分析静脉溶栓治疗急性缺血性脑卒中患者的疗效及预后，探讨时间管理对疗效的影响。方法 将2013年9月至2015年12月在我院脑血管病中心接受重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗的198例急性缺血性脑卒中患者，按溶栓后24 h NIHSS评分分为有效组（n=74）及无效组（n=124），单因素分析两组患者的临床资料，logistic回归分析影响疗效的因素；按3个月时改良Rankin量表（mRS）评分分为预后良好组（n=157）及预后不良组（n=41），单因素分析两组患者的临床资料，logistic回归分析影响疗效的因素。同时比较有效组及无效组间从发病至用药的各段时间的差异，评价时间管理对预后的影响。结果 有效组和无效组患者溶栓前NIHSS评分、发病至溶栓开始的时间及冠心病史差异有统计学意义（P<0.01，P<0.05），溶栓前NIHSS评分低、发病至溶栓开始的时间短、溶栓前无冠心病史是疗效良好的独立预测因素。预后良好组与预后不良组患者的年龄、发病时的血糖水平、患者的糖尿病史、房颤史、溶栓前NIHSS评分、溶栓前GCS评分及发病至溶栓开始的时间差异有统计学意义（P<0.01，P<0.05），溶栓前NIHSS评分低是预后良好的独立预测因素。在时间管理上，有效组与无效组患者，发病至溶栓开始的时间差异有统计学意义（P<0.01），且主要是由发病至就诊时间的差异（P<0.01）导致的。结论 在急性缺血性脑卒中患者的rt-PA静脉溶栓治疗中，溶栓前NIHSS评分低、发病至溶栓开始的时间短、溶栓前无冠心病史预示rt-PA静脉溶栓疗效良好，溶栓前NIHSS评分低预示静脉溶栓预后良好。降低患者发病至就诊的时间可提高静脉溶栓的疗效。 |
| 关键词: 脑梗死 血栓溶解疗法 组织型纤溶酶原激活物 时间安排 入院到进针时间 |
| DOI：10.16781/j.0258-879x.2016.10.1206 |
| 投稿时间：2016-04-26修订日期：2016-09-04 |
| 基金项目:上海市科委医学引导项目（124119a8900），上海申康医院发展中心临床管理优化项目（SHDC2015607）. |
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| Influence of time management on intravenous thrombolysis outcome in acute ischemic stroke |
| ZHANG Min-min,WU Xiong-feng,CHEN Lei,JIANG Yi,ZHU Xuan,ZHANG Yong-wei,WU Tao,DENG Ben-qiang* |
(Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the efficacy and prognosis of intravenous thrombolysis in patients with acute ischemic stroke, so as to discuss the influence of time management on the thrombolysis outcome. Methods We retrospectively analyzed the clinical data of the 198 acute ischemic stroke patients who received intravenous thrombolysis in Changhai Hospital from Sep. 2013 to Dec. 2015. The patients were divided into two groups according to U. S. National Institutes of Health Stroke Scale (NIHSS) scores 24 h after thrombolysis:effective group and ineffective group. The clinical data of the two groups were compared to indentify the factors influencing the prognosis. The patients were also divided into two groups according to modified Rankin Scale (mRS) after 90 d:good prognosis and poor prognosis groups; the clinical data of the two groups were also analyzed to identify the influencing factors. The differences were compared between the effective group and ineffective group from the onset to different medication periods, so as to evaluate the influence of time management on prognosis. Results The 198 consecutive acute ischemic stroke patients included 74 in the effective group and 124 in the ineffective group. Single-factor analysis indicated that the pre-thrombolysis baseline NIHSS score, time from onset to the beginning of thrombolysis, and history of coronary heart disease were significantly different between the effective group and ineffective group (P<0.01, P<0.05).Logistic regression analysis showed that low baseline NIHSS score before thrombolysis, shorter time from onset to the beginning of thrombolysis, and no history of coronary heart disease were the independent predictors of a good effect. Single-factor analysis of indicated that the age, blood glucose level prior to thrombolysis, history of diabetes mellitus, history of atrial fibrillation, baseline NIHSS score and GCS score prior to thrombolysis, time from onset to the beginning of thrombolysis and history of coronary heart disease were significantly different between the good prognosis group (157 cases) and the poor prognosis group (41 cases) (P<0.01, P<0.05). Logistic regression analysis showed that low baseline NIHSS score before thrombolysis were independent predictors of good prognosis. Concerning the time management, the time periods from onset to the beginning of thrombolysis were significantly different between the ineffective group and effective group (P<0.01), which was mainly caused by the time from the onset to treatment (P<0.01). Conclusion Lower pre-thrombolysis NIHSS score, shorter time from stroke onset to beginning of thrombolysis, no history of coronary heart disease are associated with good short-term efficacy, and lower pre-thrombolysis NIHSS score is the independent factor of good prognosis for acute ischemic stroke. Early treatment may increase the efficacy of intravenous thrombolysis. |
| Key words: brain infarction thrombolytic therapy tissue plasminogen activator time management door-to-needle time |
