本文選題：缺血性卒中　切入點(diǎn)：阿替普酶　出處：《華北理工大學(xué)》2017年碩士論文

【摘要】：目的近年來,腦血管疾病已躍居城市第二位、農(nóng)村第一位死亡原因,其中急性缺血性腦卒中致殘、致死率極高,嚴(yán)重威脅患者生命健康,為個(gè)人乃至社會(huì)帶去沉重的生活、經(jīng)濟(jì)負(fù)擔(dān)。阿替普酶(rt-PA)作為一種重組組織型纖溶酶原激活劑,是目前世界上唯一被批準(zhǔn)并推薦用于治療急性缺血性腦卒中的一線藥物,然而相當(dāng)一部分患者并未從溶栓治療中獲益,發(fā)生早期神經(jīng)功能惡化(Early Neurological Deterioration,END),病情進(jìn)一步發(fā)展。本研究旨在探討阿替普酶靜脈溶栓治療的急性缺血性卒中患者發(fā)生早期神經(jīng)功能惡化的危險(xiǎn)因素。方法本研究回顧性分析自2006年1月至2015年5月連續(xù)登記的發(fā)病4.5小時(shí)內(nèi)給予阿替普酶靜脈溶栓治療的急性缺血性卒中患者,按照溶栓后是否發(fā)生早期神經(jīng)功能惡化(早期神經(jīng)功能惡化定義為:溶栓后24小時(shí)內(nèi)NIHSS評(píng)分較基線增加≥4分或死亡)分為惡化組(END組)和非惡化組(n END組)。危險(xiǎn)因素分析采用多因素Logistic回歸模型計(jì)算比值比(OR值)及其95%置信區(qū)間(95%CI)。結(jié)果本研究共納入220例發(fā)病4.5小時(shí)內(nèi)給予阿替普酶靜脈溶栓治療的急性缺血性卒中患者,其中34例(15.5%)經(jīng)阿替普酶靜脈溶栓治療后24小時(shí)內(nèi)發(fā)生早期神經(jīng)功能惡化。經(jīng)多因素Logistic回歸分析顯示:年齡(每增加10歲:OR=1.963,95%CI=1.067-3.614)、入院血糖(每增加1mmol/L:OR=1.409,95%CI=1.191-1.667)、白細(xì)胞計(jì)數(shù)(每增加1×109/L:OR=1.197,95%CI=1.018-1.409)、基線NIHSS評(píng)分(每增加1分:OR=1.267,95%CI=1.091-1.475)、吞咽障礙(OR=4.312,95%CI=1.131-16.435)、昏迷(OR=22.314,95%CI=1.385-359.505)、責(zé)任大血管閉塞(OR=11.739,95%CI=2.600-52.999)和TOAST分型中的心源性腦栓塞(OR=3.671,95%CI=1.090-12.367)與阿替普酶靜脈溶栓后發(fā)生早期神經(jīng)功能惡化顯著相關(guān)(P0.05),為其獨(dú)立影響因素。結(jié)論本研究結(jié)果顯示:高齡、較高的入院隨機(jī)血糖水平、白細(xì)胞計(jì)數(shù)及基線NIHSS評(píng)分、吞咽障礙、昏迷、責(zé)任大血管閉塞及TOAST分型為心源性腦栓塞類型的患者發(fā)病4.5小時(shí)內(nèi)給予阿替普酶靜脈溶栓治療后更容易發(fā)生早期神經(jīng)功能惡化。對(duì)于這些患者,臨床醫(yī)生應(yīng)該加強(qiáng)溶栓前的溝通,慎重使用阿替普酶靜脈溶栓,溶栓后需密切觀察病情變化,必要時(shí)盡早進(jìn)行橋接血管內(nèi)治療。
[Abstract]:Objective in recent years, cerebrovascular diseases have become the second most important cause of death in urban areas and the first cause of death in rural areas. Among them, acute ischemic stroke causes disability, resulting in a very high mortality rate, which seriously threatens the life and health of patients and brings a heavy life to individuals and society. As a recombinant tissue type plasminogen activator, Atip rt-PAA is the only first-line drug approved and recommended for the treatment of acute ischemic stroke in the world. However, a significant number of patients did not benefit from thrombolytic therapy, The purpose of this study was to investigate the risk factors of early neurological deterioration in patients with acute ischemic stroke treated by intravenous thrombolytic therapy with atropine. Methods the purpose of this study was to investigate the risk factors of early neurological deterioration in patients with acute ischemic stroke treated by intravenous thrombolytic therapy. An analysis of patients with acute ischemic stroke who received intravenous thrombolytic therapy with atropine within 4.5 hours of consecutive onset from January 2006 to May 2015, According to whether early nerve function deterioration occurred after thrombolysis (defined as: the NIHSS score increased more than 4 points or died from baseline within 24 hours after thrombolysis), the patients were divided into two groups: end group and END group. Multivariate Logistic regression model was used to calculate odds ratio (OR) and 95% confidence interval (95% CI). Results 220 patients with acute ischemic stroke who received intravenous thrombolytic therapy with atropine within 4.5 hours after onset of the disease were included in this study. Early neurological deterioration occurred within 24 hours after intravenous thrombolytic therapy with atropase in 34 patients. Multivariate Logistic regression analysis showed that age (1.96395 CI 1.067-3.614), blood glucose (1.40995CI1.191-1.667U per 1 mmol / L), leukocyte count (per increase of 10 years). Add 1 脳 10 9 / L OR 1.197 95 CI 1.018-1.409, baseline NIHSS score (1.26795 CI 1.091-1.475m / 1), dysphagia 4.31295CI1.131-16.43535, coma OR22.31495CI1.385-359.505, OR11.73995CI2.600-52.999 and TOAST type 3.67195CI1.090-12.367a). Conclusion the results of this study show that the elderly, High admission random blood glucose level, white blood cell count and baseline NIHSS score, dysphagia, coma, Patients with responsible macrovascular occlusion and TOAST classification as cardiogenic cerebral embolism were more likely to develop early neurological deterioration after intravenous thrombolytic therapy with atropine within 4.5 hours of onset. The clinicians should strengthen the communication before thrombolytic therapy and carefully use atropase in intravenous thrombolytic therapy. After thrombolytic therapy, we should closely observe the state of the disease, and carry out bridging intravascular therapy as soon as necessary.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 鄧紅瓊;李寧;;腦卒中后吞咽障礙的發(fā)生機(jī)制研究進(jìn)展[J];中華老年心腦血管病雜志;2014年09期

2 ;第三次全國死因調(diào)查主要情況[J];中國腫瘤;2008年05期

3 賈麗君;遲魯梅;范佳;劉群;;進(jìn)展性卒中的臨床分析[J];中風(fēng)與神經(jīng)疾病雜志;2008年02期

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本文編號(hào)：1662728