国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2011年
10期
770-775
,共6页
卒中%脑缺血%血栓溶解疗法%纤维蛋白溶解药%组织型纤溶酶原激活物%尿激酶%治疗结果
卒中%腦缺血%血栓溶解療法%纖維蛋白溶解藥%組織型纖溶酶原激活物%尿激酶%治療結果
졸중%뇌결혈%혈전용해요법%섬유단백용해약%조직형섬용매원격활물%뇨격매%치료결과
Stroke%Brain ischemia%Thrombolytic therapy%Fibrinolytic agents%Urokinase%Tissue plasminogen activator%Treatment outcome%influential factors
目的 探讨急性缺血性卒中患者动脉溶栓治疗的远期转归及其影响因素.方法 纳入接受动脉溶栓的急性缺血性卒中患者,利用改良Rankin量表(modified Rankin Scale,mRS)评价溶栓治疗90d时的神经功能转归,根据评价结果分为转归良好组(mRS评分0～2分)和转归不良组(mRS评分3～6分)；根据急性心肌梗死溶栓试验(Thrombolysis in Myocardial Infarction,TIMI)分级标准评价溶栓后血管再通程度；记录溶栓治疗后7d内颅内出血发生率以及3个月时的病死率.利用单变量分析和多变量logistic回归分析筛选动脉溶栓远期转归的影响因素.结果 共纳入42例接受动脉溶栓的急性缺血性卒中患者,19例(45.2％)转归良好,23例(54.8％)转归不良；27例(64.5％)血管再通良好(TIMI分级2～3级)；13例7d内发生颅内出血(31.0％),其中有症状颅内出血8例(19.0％)；11例(26.2％)在90d内死亡.单变量分析显示,基线血糖水平(P=0.019)、基线美国国立卫生研究院卒中量表评分(P =0.014)、有症状颅内出血(P=0.005)和血管再通程度(P=0.002)均可影响动脉溶栓患者的远期转归.多变量logistic回归分析提示,基线血糖水平较低和血管再通良好是急性缺血性卒中患者动脉溶栓治疗后远期转归良好的独立预测因素.结论 对于急性缺血性卒中患者,在排除禁忌证后进行动脉溶栓安全、有效；入院时血糖水平较低和溶栓后血管再通良好与动脉溶栓远期转归良好相关.
目的 探討急性缺血性卒中患者動脈溶栓治療的遠期轉歸及其影響因素.方法 納入接受動脈溶栓的急性缺血性卒中患者,利用改良Rankin量錶(modified Rankin Scale,mRS)評價溶栓治療90d時的神經功能轉歸,根據評價結果分為轉歸良好組(mRS評分0～2分)和轉歸不良組(mRS評分3～6分)；根據急性心肌梗死溶栓試驗(Thrombolysis in Myocardial Infarction,TIMI)分級標準評價溶栓後血管再通程度；記錄溶栓治療後7d內顱內齣血髮生率以及3箇月時的病死率.利用單變量分析和多變量logistic迴歸分析篩選動脈溶栓遠期轉歸的影響因素.結果 共納入42例接受動脈溶栓的急性缺血性卒中患者,19例(45.2％)轉歸良好,23例(54.8％)轉歸不良；27例(64.5％)血管再通良好(TIMI分級2～3級)；13例7d內髮生顱內齣血(31.0％),其中有癥狀顱內齣血8例(19.0％)；11例(26.2％)在90d內死亡.單變量分析顯示,基線血糖水平(P=0.019)、基線美國國立衛生研究院卒中量錶評分(P =0.014)、有癥狀顱內齣血(P=0.005)和血管再通程度(P=0.002)均可影響動脈溶栓患者的遠期轉歸.多變量logistic迴歸分析提示,基線血糖水平較低和血管再通良好是急性缺血性卒中患者動脈溶栓治療後遠期轉歸良好的獨立預測因素.結論 對于急性缺血性卒中患者,在排除禁忌證後進行動脈溶栓安全、有效；入院時血糖水平較低和溶栓後血管再通良好與動脈溶栓遠期轉歸良好相關.
목적 탐토급성결혈성졸중환자동맥용전치료적원기전귀급기영향인소.방법 납입접수동맥용전적급성결혈성졸중환자,이용개량Rankin량표(modified Rankin Scale,mRS)평개용전치료90d시적신경공능전귀,근거평개결과분위전귀량호조(mRS평분0～2분)화전귀불량조(mRS평분3～6분)；근거급성심기경사용전시험(Thrombolysis in Myocardial Infarction,TIMI)분급표준평개용전후혈관재통정도；기록용전치료후7d내로내출혈발생솔이급3개월시적병사솔.이용단변량분석화다변량logistic회귀분석사선동맥용전원기전귀적영향인소.결과 공납입42례접수동맥용전적급성결혈성졸중환자,19례(45.2％)전귀량호,23례(54.8％)전귀불량；27례(64.5％)혈관재통량호(TIMI분급2～3급)；13례7d내발생로내출혈(31.0％),기중유증상로내출혈8례(19.0％)；11례(26.2％)재90d내사망.단변량분석현시,기선혈당수평(P=0.019)、기선미국국립위생연구원졸중량표평분(P =0.014)、유증상로내출혈(P=0.005)화혈관재통정도(P=0.002)균가영향동맥용전환자적원기전귀.다변량logistic회귀분석제시,기선혈당수평교저화혈관재통량호시급성결혈성졸중환자동맥용전치료후원기전귀량호적독립예측인소.결론 대우급성결혈성졸중환자,재배제금기증후진행동맥용전안전、유효；입원시혈당수평교저화용전후혈관재통량호여동맥용전원기전귀량호상관.
Objective To investigate the long-term outcome of intra-arterial thrombolysis in patients with acute ischemic stroke and its influencing factors.Methods Patients with acute ischemic stroke received intra-arterial thrombolysis were included in the study.The neurological outcome at day 90 was assessed using the modified Rankin Scale (mRS).They were divided into the good outcome group (mRS scores,0 to 2) and the poor outcome group (mRS scores,3 to 6)according to the evaluation results; the degree of recanalization after thrombolysis was assessed by the grading criteria of the Thrombolysis in Myocardial Infarction (TIMI) trial; the incidence of intracerebral hemorrhage within 7 days after thrombolytic therapy and the mortality at 3months were recorded.Univariate analysis and multivariate logistic regression analysis were used to screen the influencing factors of long-term outcome of arterial thrombolysis.Results A total of 42 patients were included,of them,19 (45.2％) with good outcome and 23 (54.8％) with poor outcome after intra-arterial thrombolysis; 27 patients (64.5％ ) with good recanalization (TIMI grade,2 to 3); 13 patients (31.0％) occurred intracranial hemorrhage within 7 days,and 8 of them (19.0％ ) had symptomatic intracranial hemorrhage; 11 (26.2％ ) died within 90 days.Univariate analysis showed that the baseline blood glucose levels (P=0.019),the baseline National Institutes of Health Stroke Scale (NIHSS) scores (P =0.014),symptomatic intracranial hemorrhage (P =0.005),and the degree of recanalization (P =0.002) could influence the longterm outcome of patients with intra-arterial thrombolysis.Multivariate logistic regression analysis indicated that the lower level of basdine glucose and good recanalization were the independent predictive factors of the good long-term outcome after intra-arterial thrombolysis in patients with acute ischemic stroke.Conclusion After the exclusion of contraindications,the intra-arterial thrombolysis was safe and effective for patients with acute ischemic stroke.The lower blood glucose levels on admission and the good recanalization after thrombolysis were associated with the good long-term outcome of intm-arterial thrombolysis.
