本文選題：急性腦梗死 + 靜脈溶栓��； 參考：《浙江大學(xué)》2013年碩士論文

【摘要】：目的 觀察rt-PA靜脈溶栓后急性腦梗死患者3個(gè)月末的認(rèn)知功能,分析腦梗死后血管性認(rèn)知功能損害與rt-PA靜脈溶栓的相關(guān)性。 方法 前瞻性觀察金華市中醫(yī)院神經(jīng)內(nèi)科連續(xù)收集的首發(fā)急性腦梗死患者,根據(jù)是否接受rt-PA靜脈溶栓治療分為溶栓組和非溶栓組(對(duì)照組)。比較兩組間年齡、性別、重要部位梗死(額葉、顳葉、丘腦、基底節(jié))、教育程度、高血壓史、房顫史、收縮壓、舒張壓、C反應(yīng)蛋白、代謝障礙情況(糖尿病史、高血脂史、空腹血糖、空腹低密度脂蛋白)等基線因素,動(dòng)態(tài)觀察兩組間入院24小時(shí)內(nèi)及3個(gè)月末的認(rèn)知功能,采用MMSE、MoCA評(píng)分,應(yīng)用SPSS統(tǒng)計(jì)軟件,單因素及多因素logistic回歸分析認(rèn)知功能與rt-PA靜脈溶栓的相關(guān)性。 結(jié)果 43例患者納入本次研究,其中溶栓組為21例,對(duì)照組22例。單因素分析結(jié)果顯示：溶栓組與對(duì)照組上述基線數(shù)據(jù)無統(tǒng)計(jì)學(xué)差異；3個(gè)月末溶栓組與對(duì)照組MoCA(P0.05, P=0.036)、MMSE (P0.05, P=0.029)評(píng)分均有差異。 3個(gè)月末使用MMSE量表測定認(rèn)知功能：單因素分析顯示高血壓史、年齡、C反應(yīng)蛋白、rt-PA靜脈溶栓、重要部位梗死、教育程度是影響認(rèn)知功能的重要因素(P0.05)。多因素分析顯示年齡(OR0.674,95%CI0.410-0.887, P=0.048)、梗死部位(OR0.355,95%CI0.127-0.536, P=0.037)是血管性認(rèn)知功能損害的獨(dú)立危險(xiǎn)因子。而rt-PA靜脈溶栓(OR1.521,95%CI1.304-1.780, P=0.041)是血管性認(rèn)知功能損害的獨(dú)立保護(hù)因子。 3個(gè)月末使用MoCA量表測定認(rèn)知功能：單因素分析顯示年齡、rt-PA靜脈溶栓、重要部位梗死、教育程度是影響認(rèn)知功能的重要因素(P0.05)。多因素分析顯示年齡(OR0.536,95%CI0.357-0.763, P=0.040)、重要部位梗死(OR0.262,95%CI0.065-0.574, P=0.026)是血管性認(rèn)知功能損害的獨(dú)立危險(xiǎn)因子,而rt-PA靜脈溶栓(OR1.701,95%CI1.461-1.975, P=0.033)、教育程度(OR1.361,95%CI1.108-1.635, P=0.042)是血管性認(rèn)知功能損害的獨(dú)立保護(hù)因子。 結(jié)論 rt-PA靜脈溶栓對(duì)腦梗死后患者認(rèn)知功能有影響,rt-PA靜脈溶栓是影響腦梗死患者3個(gè)月末認(rèn)知功能的獨(dú)立保護(hù)因子。
[Abstract]:Purpose To observe the cognitive function of patients with acute cerebral infarction after rt-PA intravenous thrombolysis for 3 months, and to analyze the correlation between vascular cognitive impairment and venous thrombolysis of rt-PA after cerebral infarction. Method The first acute cerebral infarction patients collected continuously from Department of Neurology of Jinhua traditional Chinese Medicine Hospital were prospectively observed and divided into thrombolytic group and non-thrombolytic group according to whether they received rt-PA intravenous thrombolytic therapy (control group). Age, sex, important site infarction (frontal lobe, temporal lobe, thalamus, basal ganglia, education, history of hypertension, history of atrial fibrillation, systolic blood pressure, diastolic pressure, C-reactive protein, metabolic disorder (history of diabetes, history of hyperlipidemia) were compared between the two groups. Baseline factors such as fasting blood glucose and fasting low density lipoprotein) were used to dynamically observe cognitive function of the two groups within 24 hours of admission and 3 months after admission. MMSE MoCA score and SPSS statistical software were used. Univariate and multivariate logistic regression analysis showed the correlation between cognitive function and intravenous thrombolysis in rt-PA. Result 43 patients were included in the study, including 21 patients in thrombolysis group and 22 patients in control group. The results of univariate analysis showed that there was no significant difference in baseline data between the thrombolytic group and the control group, and the scores of MoCAG P0.05, P0.036 MMSE P0.05, P0.029) in the thrombolytic group and the control group at the end of 3 months were significantly different. At the end of 3 months, MMSE scale was used to measure cognitive function: univariate analysis showed that hypertension history, age C reactive protein rt-PA thrombolytic therapy, important site infarction, and education level were important factors affecting cognitive function (P 0.05). Multivariate analysis showed that the age of OR 0.674 / 95 and CI _ (0.410-0.887), P _ (0.048), O _ (0.355-95) CI _ (0.127-0.536), P _ (0.037) were independent risk factors for vascular cognitive impairment. The CI 1.304-1.780, Pu 0.041 were independent protective factors for vascular cognitive impairment in rt-PA intravenous thrombolytic therapy (OR 1.521 ~ 95, CI = 1.304-1.780, P = 0.041). At the end of 3 months, MoCA scale was used to measure cognitive function: univariate analysis showed that age patients with rt-PA thrombolytic therapy, important site infarction, and education level were the important factors affecting cognitive function (P 0.05). Multivariate analysis showed that the age of OR0.536-95CI0.357-0.763, P0. 040, important site infarction OR0. 262 ~ 95 CI0.065-0.574, P0. 026) were independent risk factors of vascular cognitive impairment, while rt-PA intravenous thrombolytic thrombolysis OR1. 70195CI1. 461-1.975, P0.033, educational level OR1. 361, 95CI1. 108-1.635, P0. 042) were independent protective factors of vascular cognitive impairment. Conclusion The effect of rt-PA intravenous thrombolytic therapy on cognitive function of patients with cerebral infarction is that rt-PA intravenous thrombolysis is an independent protective factor affecting cognitive function of patients with cerebral infarction at the end of 3 months.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R743.3;R749.1

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