CAJ | 학술논문

目的探讨伴有心房颤动急性缺血性卒中患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓的疗效、安全性及影响预后不良的因素.方法 162例急性缺血性卒中患者在发病4.5h内接受rt-PA静脉溶栓治疗,根据患者既往史及入院时心电图结果将患者分为心房颤动组(45例)和非心房颤动组(117例),所有患者溶栓前行美国国立卫生研究院卒中量表(NIHSS)评分,溶栓后3个月行改良Rakin量表(mRS)评分.结果 (1)心房颤动组的平均年龄(岁)高于非心房颤动组(69.2±11.6与62.5±12.9,t=-3.050,P=0.003),吸烟比例低于非心房颤动组[6.7％ (3/45)与28.2％(33/117),x2=8.723,P=0.003],其他基线资料比较差异无统计学意义.(2)溶栓前心房颤动与非心房颤动组NIHSS评分差异无统计学意义,心房颤动与非心房颤动组溶栓后3个月mRS评分0～1分的患者比例差异无统计学意义,心房颤动组的颅内出血比例[31.1％ (14/45)与14.5％(17/117),x2=5.774,P=0.016]及病死率[26.7％ (12/45)与12.0％(14/117),x2=5.213,P=0.022]明显高于非心房颤动组,但心房颤动与非心房颤动组症状性颅内出血比例差异无统计学意义.(3)45例心房颤动患者中,18例患者预后良好(mRS评分0～1分),预后不良27例(mRS评分2～5分).预后不良组入院时NIHSS评分(分)明显高于预后良好组(17.70±5.87与11.22 ±5.14,t=3.809,P=0.000),收缩压(mm Hg,1 mm Hg=0.133 kPa)明显低于预后良好组(145.5±24.0与164.9 ±21.0,t=-2.788,P=0.008),其他基线资料比较差异无统计学意义.(4)多因素回归分析提示心房颤动(OR=1.380,95％ CI 0.217～7.017,P=0.698)不是溶栓后死亡的独立危险因素,心房颤动(OR=3.558,95％ CI1.246～10.158,P=0.018)是溶栓后颅内出血的独立危险因素.结论心房颤动不影响急性缺血性卒中患者静脉溶栓治疗的远期疗效,心房颤动患者行静脉溶栓的颅内出血及死亡风险高于非心房颤动患者,但心房颤动不是溶栓后死亡的独立危险因素,不增加症状性颅内出血风险.入院时NIHSS评分高、收缩压低可能是心房颤动患者静脉溶栓治疗预后不良及死亡的危险因素. 目的探討伴有心房顫動急性缺血性卒中患者重組組織型纖溶酶原激活劑(rt-PA)靜脈溶栓的療效、安全性及影響預後不良的因素.方法 162例急性缺血性卒中患者在髮病4.5h內接受rt-PA靜脈溶栓治療,根據患者既往史及入院時心電圖結果將患者分為心房顫動組(45例)和非心房顫動組(117例),所有患者溶栓前行美國國立衛生研究院卒中量錶(NIHSS)評分,溶栓後3箇月行改良Rakin量錶(mRS)評分.結果 (1)心房顫動組的平均年齡(歲)高于非心房顫動組(69.2±11.6與62.5±12.9,t=-3.050,P=0.003),吸煙比例低于非心房顫動組[6.7％ (3/45)與28.2％(33/117),x2=8.723,P=0.003],其他基線資料比較差異無統計學意義.(2)溶栓前心房顫動與非心房顫動組NIHSS評分差異無統計學意義,心房顫動與非心房顫動組溶栓後3箇月mRS評分0～1分的患者比例差異無統計學意義,心房顫動組的顱內齣血比例[31.1％ (14/45)與14.5％(17/117),x2=5.774,P=0.016]及病死率[26.7％ (12/45)與12.0％(14/117),x2=5.213,P=0.022]明顯高于非心房顫動組,但心房顫動與非心房顫動組癥狀性顱內齣血比例差異無統計學意義.(3)45例心房顫動患者中,18例患者預後良好(mRS評分0～1分),預後不良27例(mRS評分2～5分).預後不良組入院時NIHSS評分(分)明顯高于預後良好組(17.70±5.87與11.22 ±5.14,t=3.809,P=0.000),收縮壓(mm Hg,1 mm Hg=0.133 kPa)明顯低于預後良好組(145.5±24.0與164.9 ±21.0,t=-2.788,P=0.008),其他基線資料比較差異無統計學意義.(4)多因素迴歸分析提示心房顫動(OR=1.380,95％ CI 0.217～7.017,P=0.698)不是溶栓後死亡的獨立危險因素,心房顫動(OR=3.558,95％ CI1.246～10.158,P=0.018)是溶栓後顱內齣血的獨立危險因素.結論心房顫動不影響急性缺血性卒中患者靜脈溶栓治療的遠期療效,心房顫動患者行靜脈溶栓的顱內齣血及死亡風險高于非心房顫動患者,但心房顫動不是溶栓後死亡的獨立危險因素,不增加癥狀性顱內齣血風險.入院時NIHSS評分高、收縮壓低可能是心房顫動患者靜脈溶栓治療預後不良及死亡的危險因素.
목적 탐토반유심방전동급성결혈성졸중환자중조조직형섬용매원격활제(rt-PA)정맥용전적료효、안전성급영향예후불량적인소.방법 162례급성결혈성졸중환자재발병4.5h내접수rt-PA정맥용전치료,근거환자기왕사급입원시심전도결과장환자분위심방전동조(45례)화비심방전동조(117례),소유환자용전전행미국국립위생연구원졸중량표(NIHSS)평분,용전후3개월행개량Rakin량표(mRS)평분.결과 (1)심방전동조적평균년령(세)고우비심방전동조(69.2±11.6여62.5±12.9,t=-3.050,P=0.003),흡연비례저우비심방전동조[6.7％ (3/45)여28.2％(33/117),x2=8.723,P=0.003],기타기선자료비교차이무통계학의의.(2)용전전심방전동여비심방전동조NIHSS평분차이무통계학의의,심방전동여비심방전동조용전후3개월mRS평분0～1분적환자비례차이무통계학의의,심방전동조적로내출혈비례[31.1％ (14/45)여14.5％(17/117),x2=5.774,P=0.016]급병사솔[26.7％ (12/45)여12.0％(14/117),x2=5.213,P=0.022]명현고우비심방전동조,단심방전동여비심방전동조증상성로내출혈비례차이무통계학의의.(3)45례심방전동환자중,18례환자예후량호(mRS평분0～1분),예후불량27례(mRS평분2～5분).예후불량조입원시NIHSS평분(분)명현고우예후량호조(17.70±5.87여11.22 ±5.14,t=3.809,P=0.000),수축압(mm Hg,1 mm Hg=0.133 kPa)명현저우예후량호조(145.5±24.0여164.9 ±21.0,t=-2.788,P=0.008),기타기선자료비교차이무통계학의의.(4)다인소회귀분석제시심방전동(OR=1.380,95％ CI 0.217～7.017,P=0.698)불시용전후사망적독립위험인소,심방전동(OR=3.558,95％ CI1.246～10.158,P=0.018)시용전후로내출혈적독립위험인소.결론 심방전동불영향급성결혈성졸중환자정맥용전치료적원기료효,심방전동환자행정맥용전적로내출혈급사망풍험고우비심방전동환자,단심방전동불시용전후사망적독립위험인소,불증가증상성로내출혈풍험.입원시NIHSS평분고、수축압저가능시심방전동환자정맥용전치료예후불량급사망적위험인소.
Objective To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in acute cerebral infarct patients with atrial fibrillation (AF) and the predicting factors of poor prognosis.Methods Totally 162 patients with acute cerebral infarct were treated with rt-PA within 4.5 hours from the onset.According to past history and the electrocardiogram,the patients was classified into AF (n =45) and non-AF (n =117) groups.The baseline National Institute of Health Stroke Scale (NIHSS) scores and Modified Rankin Scale(mRS) scores 3 months after onset were collected.Results (1) The mean age in AF group was higher than non-AF group (69.2 ± 11.6 vs 62.5 ±12.9,t =-3.050,P =0.003),the smoking rate was higher in non-AF group (6.7％ (3/45)vs 28.2％ (33/117),x2 =8.723,P =0.003).Others had no statistically significance.(2) The baseline NIHSS scores was not significantly different between AF and non-AF group.There was no statistically significance in the rate of mRS 0-1 scores in the 2 groups after 3 months.The rate of hemorrhagic transformation (31.1％ (14/45) vs 14.5％ (17/117),x2 =5.774,P =0.016) and mortality rate (26.7％ (12/45) vs 12.0％ (14/117),x2 =5.213,P =0.022) was higher in AF group than non-AF group.But the rate of symptomatic intracranial hemorrhage was not significantly different between AF and non-AF group.(3) In All 45 patients with AF,the prognosis of 18 patients was well (mRS scores 0-1) while 27 patients were poor (mRS scores 2-5).The NIHSS scores in poor prognosis group was higher than good prognosis group (17.70 ± 5.87 vs 11.22 ±5.14,t =3.809,P =0.000),while systolic blood pressure in poor prognosis group was lower than good prognosis group (145.5 ± 24.0 vs 164.9 ± 21.0,t =-2.788,P =0.008).(4) Multivariate regression analysis suggests that AF (OR =1.380,95％ CI 0.217-7.017,P =0.698) was not an independent risk factor for death after thrombolysis,but AF (OR ＝ 3.558,95％ CI 1.246-10.158,P =0.018) was an independent risk factor for intracerebral hemorrhage.Conclusions The presence of AF doesn' t affect the 3 months mRS of the acute cerebral infarct patients after the intravenous thrombolysis.There are higher rate of hemorrhagic transformation and mortality in AF patient.But AF is not an independent risk factor of death while it doesn' t increased the risk of symptomatic intracranial hemorrhage.High NIHSS scores and low systolic blood pressure are risk factor of poor prognosis or even death in AF patients after thrombolytic therapy.