心源性卒中重組組織型纖溶酶原激活劑靜脈溶栓治療的療效觀察
發(fā)布時(shí)間：2018-08-06 20:49
【摘要】：目的:觀察心源性卒中患者重組組織型纖溶酶原激活劑(rt-PA)靜脈溶栓治療的療效。方法:前瞻性收集發(fā)病4.5h內(nèi)接受rt-PA靜脈溶栓治療的急性缺血性卒中患者,根據(jù)TOAST分型標(biāo)準(zhǔn),將所有患者分為心源性卒中組、非心源性卒中組兩組,比較兩組患者早期療效、遠(yuǎn)期預(yù)后以及癥狀性顱內(nèi)出血(slCH)發(fā)生率、死亡率。結(jié)果:共94例患者納入研究,其中心源性卒中組33例,非心源性卒中組61例,心源性卒中組患者當(dāng)前吸煙比例低于非心源性卒中組[9.1%(3/33)與36.1%(22/61),χ2=7.892,P=0.005],心源性卒中組心房顫動(dòng)比例明顯高于非心源性卒中組[72.7%(24/33)與4.9%(3/61),χ2=48.096,P0.001],入院時(shí)NIHSS評(píng)分等其他基線資料比較差異無統(tǒng)計(jì)學(xué)意義。兩組溶栓后24h、出院時(shí)NIHSS評(píng)分及NIHSS評(píng)分下降程度比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);心源性卒中組出院時(shí)神經(jīng)功能改善率低于非心源性卒中組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);心源性卒中組遠(yuǎn)期預(yù)后良好率低于非心源性卒中組[24.2%(8/33)與47.5%(29/61),χ2=4.870,P=0.027],心源性卒中組slCH發(fā)生率、死亡率均高于非心源性卒中組,分別為[18.2%(6/33)與4.9%(3/61),χ2=4.352,P=0.037]、[18.2%(6/33)與6.6%(4/61),χ2=4.451,P=0.035],多因素回歸分析顯示,在校正年齡、血糖、溶栓前24h抗血小板或抗凝、當(dāng)前吸煙、房顫、基線NIHSS評(píng)分的因素后,心源性卒中組s ICH發(fā)生風(fēng)險(xiǎn)約是非心源性卒中組的5倍(OR:5.12;95%CI:0.13-21.45;P=0.039);死亡風(fēng)險(xiǎn)約是非心源性卒中的3倍(OR:2.98;95%CI:0.74-12.76 P=0.048);出院時(shí)神經(jīng)功能改善率與90天預(yù)后良好率顯著低于非心源性卒中組,分別為(OR:0.41;95%CI:0.13-1.02;P=0.045)、(OR:0.36;95%CI:0.14-0.93;P=0.031)。結(jié)論:心源性卒中rt-PA靜脈溶栓治療早期療效及遠(yuǎn)期預(yù)后較非心源性卒中差,slCH發(fā)生率及死亡率高于非心源性卒中,因此,應(yīng)積極預(yù)防心源性卒中的發(fā)生。
[Abstract]:Objective: to observe the effect of intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) in patients with cardiogenic stroke. Methods: patients with acute ischemic stroke received intravenous thrombolytic therapy with rt-PA within 4.5 hours after onset were prospectively collected. According to the criteria of TOAST classification, all patients were divided into two groups: cardiogenic stroke group and non-cardiogenic stroke group. The early curative effects of the two groups were compared. Long-term prognosis, (slCH) incidence and mortality of symptomatic intracranial hemorrhage. Results: a total of 94 patients were included in the study, including 33 patients with cardiogenic stroke and 61 patients with non-cardiogenic stroke. The prevalence of smoking in cardiogenic stroke group was significantly lower than that in non-cardiogenic stroke group [9.1% (3 / 33) vs 36.1% (22 / 61), 蠂 ~ 2 = 7.892 P0. 005]. The rate of atrial fibrillation in cardiogenic stroke group was significantly higher than that in non-cardiogenic stroke group [72.7% (24 / 33) vs 4.9% (3 / 61), 蠂 ~ 2 / 48.096 P0.001]. There was no significant difference in other baseline data such as NIHSS score at admission. At 24 hours after thrombolysis, there was a significant difference in NIHSS score and NIHSS score between the two groups (P0.05), and the improvement rate of neurological function in cardiogenic stroke group was lower than that in non-cardiogenic stroke group at discharge (P0.05). The long-term good prognosis rate in cardiogenic stroke group was significantly lower than that in non-cardiogenic stroke group [24.2% (8 / 33) vs 47.5% (29 / 61), 蠂 ~ 2 + 4.870 P 0.027]. The incidence of slCH in cardiogenic stroke group was higher than that in non-cardiogenic stroke group, which was [18.2% (6r33) and 4.9% (361), 蠂 ~ 2 4.352P ~ (0.037)], [18.2% (6r / 33) and 6.6% (461), 蠂 ~ (2 / 451) P ~ (0.035)]. After adjusting for age, blood glucose, anti-platelet or anticoagulant factors 24 hours before thrombolysis, current smoking, atrial fibrillation, baseline NIHSS score, The risk of ICH in cardiogenic stroke group was about 5 times as high as that in non-cardiogenic stroke group (OR: 5.1295CI0.13-21.45P0.039), and the risk of death was about three times higher than that in non-cardiogenic stroke group (OR: 2.98 ~ 95CIW 0.74-12.76 P0.048). The neurologic function improvement rate and the good prognosis rate at 90 days after discharge were significantly lower than those in non-cardiogenic stroke group (ORO: 0.4195CIW 0.13-1.02Cw 0.13-1.02P0.045), (order weight 0.3695CIo 0.14-0.93P0.031). Conclusion: the early curative effect and long-term prognosis of rt-PA in cardiogenic stroke are higher than that in non-cardiogenic stroke. Therefore, it is necessary to prevent the occurrence of cardiogenic stroke.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
本文編號(hào)：2168943
[Abstract]:Objective: to observe the effect of intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) in patients with cardiogenic stroke. Methods: patients with acute ischemic stroke received intravenous thrombolytic therapy with rt-PA within 4.5 hours after onset were prospectively collected. According to the criteria of TOAST classification, all patients were divided into two groups: cardiogenic stroke group and non-cardiogenic stroke group. The early curative effects of the two groups were compared. Long-term prognosis, (slCH) incidence and mortality of symptomatic intracranial hemorrhage. Results: a total of 94 patients were included in the study, including 33 patients with cardiogenic stroke and 61 patients with non-cardiogenic stroke. The prevalence of smoking in cardiogenic stroke group was significantly lower than that in non-cardiogenic stroke group [9.1% (3 / 33) vs 36.1% (22 / 61), 蠂 ~ 2 = 7.892 P0. 005]. The rate of atrial fibrillation in cardiogenic stroke group was significantly higher than that in non-cardiogenic stroke group [72.7% (24 / 33) vs 4.9% (3 / 61), 蠂 ~ 2 / 48.096 P0.001]. There was no significant difference in other baseline data such as NIHSS score at admission. At 24 hours after thrombolysis, there was a significant difference in NIHSS score and NIHSS score between the two groups (P0.05), and the improvement rate of neurological function in cardiogenic stroke group was lower than that in non-cardiogenic stroke group at discharge (P0.05). The long-term good prognosis rate in cardiogenic stroke group was significantly lower than that in non-cardiogenic stroke group [24.2% (8 / 33) vs 47.5% (29 / 61), 蠂 ~ 2 + 4.870 P 0.027]. The incidence of slCH in cardiogenic stroke group was higher than that in non-cardiogenic stroke group, which was [18.2% (6r33) and 4.9% (361), 蠂 ~ 2 4.352P ~ (0.037)], [18.2% (6r / 33) and 6.6% (461), 蠂 ~ (2 / 451) P ~ (0.035)]. After adjusting for age, blood glucose, anti-platelet or anticoagulant factors 24 hours before thrombolysis, current smoking, atrial fibrillation, baseline NIHSS score, The risk of ICH in cardiogenic stroke group was about 5 times as high as that in non-cardiogenic stroke group (OR: 5.1295CI0.13-21.45P0.039), and the risk of death was about three times higher than that in non-cardiogenic stroke group (OR: 2.98 ~ 95CIW 0.74-12.76 P0.048). The neurologic function improvement rate and the good prognosis rate at 90 days after discharge were significantly lower than those in non-cardiogenic stroke group (ORO: 0.4195CIW 0.13-1.02Cw 0.13-1.02P0.045), (order weight 0.3695CIo 0.14-0.93P0.031). Conclusion: the early curative effect and long-term prognosis of rt-PA in cardiogenic stroke are higher than that in non-cardiogenic stroke. Therefore, it is necessary to prevent the occurrence of cardiogenic stroke.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【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2條
1 高峰;徐安定;;急性缺血性卒中血管內(nèi)治療中國指南2015[J];中國卒中雜志;2015年07期
2 王志宏;韓仲巖;;急性缺血性腦卒中的TOAST分型標(biāo)準(zhǔn)[J];臨床神經(jīng)病學(xué)雜志;2007年05期
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