目的 探讨急性脑梗死(acute cerebral infarction, ACI)患者静脉溶栓后早期神经功能恶化(early neurological deterioration,END)的危险因素。方法 选择2014-01至2019-01发病4.5 h内行阿替普酶静脉溶栓的ACI患者,根据溶栓后是否发生END将患者分为END组和非恶化组,比较两组人口统计学、临床特征和实验室指标。采用多变量Logistic回归分析ACI患者静脉溶栓后END的危险因素。结果 共纳入ACI患者108例,其中END组19例。END组年龄、体重、心房纤颤比例、基线NIHSS评分、责任大血管狭窄或闭塞、白细胞计数、纤维蛋白原水平均显著高于非恶化组。多变量 Logistic回归分析显示,年龄(OR=3.285;95%CI:2.023～5.682;P=0.028)、体重(OR=2.679;95%CI:1.690～6.287;P=0.039)、心房纤颤(OR=2.551;95%CI:1.980～4.235;P=0.027)、基线NIHHSS评分(OR=3.627;95%CI:6.267～13.331;P=0.018)、纤维蛋白原水平(OR=2.016;95%CI:4.650～7.823;P=0.031)均与ACI患者静脉溶栓后END显著相关。结论 ACI患者静脉溶栓后END发生率较高,年龄、体重、心房纤颤、基线NIHSS评分、纤维蛋白原为ACI患者静脉溶栓治疗后发生END的危险因素。
Abstract
Objective To investigate the risk factors for early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction.Methods Patients with acute cerebral infarction were selected, who were treated with alteplase thrombolytic therapy within 4.5 h of the onset in our hospital between January 2014 and January 2019. These patients were divided into the early neurological deterioration group and the non-deterioration group according to the occurrence of early neurological deterioration. Demographics, clinical data, and laboratory test indicators were compared between the two groups. The risks factors for early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction were analyzed by using multivariate logistic regression analysis.Results A total of 108 patients with acute cerebral infarction were included in the study, 19 of whom were in the early neurological deterioration group. The age, body weight, proportion of atrial fibrillation, baseline NIHSS score, proportion of major vessel narrow or occlusion, white blood cell counts, and levels of fibrinogen in the early neurological deterioration group were significantly above those in the non-deterioration group. Multivariate logistic regression analysis showed that age(OR=3.285; 95%CI:2.023-5.682; P=0.028),body weight(OR=2.679; 95%CI:1.690-6.287; P=0.039), atrial fibrillation(OR=2.551; 95%CI:1.980-4.235; P=0.027), baseline NIHSS score(OR=3.627; 95%CI:6.267-13.331; P=0.018), and levels of fibrinogen(OR=2.016; 95%CI:4.650-7.823; P=0.031) were significantly correlated with early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction.Conclusions The incidence of early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction is relatively high. Age, body weight, atrial fibrillation, baseline NIHSS scores, and levels of fibrinogen are risk factors for early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction.
关键词
急性脑梗死 /
静脉溶栓 /
早期神经功能恶化 /
危险因素
Key words
acute cerebral infarction /
intravenous thrombolysis /
early neurological deterioration /
risk factors
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