CAJ | 학술논문

目的：观察急性脑梗死患者静脉溶栓的临床疗效并分析相关的影响因素。方法：统计2010年9月—2014年6月接受重组人组织型纤溶酶原激活剂(recombinant human tissue type plasminogen activator，rt-PA)静脉溶栓治疗的急性脑梗死患者144例的一般资料，并分析所有溶栓患者的急性卒中治疗Org10172试验(trial of Org10172 in acute stroke treatment，TOAST)分型比例，通过统计无症状生存率、预后良好率和预后不良率来判断临床疗效。 Logistic多因素分析预后良好、无症状生存、颅内出血及死亡相关影响因素。结果：本组患者TOAST亚型的构成比例为：大动脉粥样硬化型50例(34.72%)，心原性脑栓塞型51例(35.42%)，小血管闭塞型23例(15.97%)，其他明确病因型2例(1.39%)，不明原因型18例(12.50%)。无症状生存60例(41.67%)，预后良好82例(56.94%)，预后不良62例(43.06%)。 Logistic分析结果显示：预后良好与给药时间、基线美国国际卫生部研究院卒中量表(NIH stroke scale，NIHSS)评分、溶栓后早期症状改善相关；无症状生存与年龄、基线NIHSS评分、早期症状改善相关；颅内出血与心房颤动病史、基线舒张压、年龄≥75岁相关；死亡与基线NIHSS评分相关。结论：我院急性脑梗死患者rt-PA静脉溶栓有较好疗效。其中大动脉粥样硬化型和心原性脑栓塞型的脑梗死患者更容易获得溶栓治疗。
목적：관찰급성뇌경사환자정맥용전적림상료효병분석상관적영향인소。방법：통계2010년9월—2014년6월접수중조인조직형섬용매원격활제(recombinant human tissue type plasminogen activator，rt-PA)정맥용전치료적급성뇌경사환자144례적일반자료，병분석소유용전환자적급성졸중치료Org10172시험(trial of Org10172 in acute stroke treatment，TOAST)분형비례，통과통계무증상생존솔、예후량호솔화예후불량솔래판단림상료효。 Logistic다인소분석예후량호、무증상생존、로내출혈급사망상관영향인소。결과：본조환자TOAST아형적구성비례위：대동맥죽양경화형50례(34.72%)，심원성뇌전새형51례(35.42%)，소혈관폐새형23례(15.97%)，기타명학병인형2례(1.39%)，불명원인형18례(12.50%)。무증상생존60례(41.67%)，예후량호82례(56.94%)，예후불량62례(43.06%)。 Logistic분석결과현시：예후량호여급약시간、기선미국국제위생부연구원졸중량표(NIH stroke scale，NIHSS)평분、용전후조기증상개선상관；무증상생존여년령、기선NIHSS평분、조기증상개선상관；로내출혈여심방전동병사、기선서장압、년령≥75세상관；사망여기선NIHSS평분상관。결론：아원급성뇌경사환자rt-PA정맥용전유교호료효。기중대동맥죽양경화형화심원성뇌전새형적뇌경사환자경용역획득용전치료。
Objective:To observe the clinical efficacy and the related influence factors of intravenous thrombolytic therapy in 144 patients with acute cerebral infarction. Methods: Records of all patients admitted to our hospital with acute ischemic stroke and received the intravenous thrombolytic therapy from September 2010 to June 2014 were retrospectively reviewed. Collecting the general information and observed the trial of Org10172 in acute stroke treatment(TOAST) classification. The clinical efficacy were judged by analyzing asymptomatic survival , favorable outcome and unfavorable outcome. The related factors of asymptomatic survival, favorable outcome, intracranial hemorrhage and mortality were identified by the Logistic analysis. Results: Of these patients, the patients were divided into 5 groups according to the TOAST classification: large-artery atherosclerosis(n=50, 34.72%), cardioembolism(n=51, 35.42%), small-artery occlusion Lacunar(n=23, 15.97%), other determined etiology(n=2, 1.39%), and undetermined etiology(n=18, 12.50%). Asymptomatic survival was 60(41.67%), favorable outcome 82(56.94%), and unfavorable outcome was 62(43.06%). Logistic analysis showed that the onset to treat-ment time, baseline NIH stroke scale(NIHSS) score and early symptom improvement were the factors associated with favor-able outcome; the age, baseline NIHSS score and early symptom improvement were the factors associated with asymptomatic survival; atrial fibrillation, diastolic blood pressure and and older than 75 year-old were the factors associated with intracra-nial hemorrhage; the baseline NIHSS score was the factor associated with mortality. Conclusion: The clinical effect of intra-venous rt-PA thrombolytic therapy in patients with acute cerebral infarction in our hospital was good. Large-artery atheroscle-rosis and cardioembolism of cerebral infarction patients were more likely to benefit from the thrombolysis treatment.