中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2015年
10期
845-849
,共5页
杨璐萌%程忻%凌倚峰%曹文杰%吴斐%方堃%董强
楊璐萌%程忻%凌倚峰%曹文傑%吳斐%方堃%董彊
양로맹%정흔%릉의봉%조문걸%오비%방곤%동강
脑梗死%组织型纤溶酶原激活物%血栓溶解疗法
腦梗死%組織型纖溶酶原激活物%血栓溶解療法
뇌경사%조직형섬용매원격활물%혈전용해요법
Brain infarction%Tissue plasminogen activator%Thrombolytic therapy
目的 明确华山医院神经内科急性缺血性脑卒中患者阿替普酶静脉溶栓治疗率,分析影响患者静脉溶栓治疗依从性的相关因素.方法 前瞻性连续收集2014年1-12月华山医院神经内科急诊疑似急性脑卒中和短暂性脑缺血发作患者,排除禁忌证后,按照是否溶栓治疗分组比较,寻找影响患者溶栓治疗依从性的相关因素.结果 2014年1-12月华山医院溶栓团队急诊评估患者共220例,排除禁忌证后,43例患者拒绝溶栓,59例接受溶栓治疗.在两组患者中影响患者是否接受溶栓治疗的单因素分析结果显示,年龄、基线NIHSS评分、肢体无力、偏瘫、面瘫或言语症状差异有统计学意义(U=936.000,P=0.024;U=284.500,P<0.01;x2=8.824,P=0.003;x2=7.732,P=0.005;x2=5.169,P=0.038;x2 =5.040,P=0.025).受试者工作特征曲线分析显示基线NIHSS评分与患者是否接受溶栓治疗有关,基线NIHSS评分<7分时,患者拒绝溶栓(敏感度0.93,特异度0.71).进一步分析2008年1月至2014年12月华山医院急性缺血性脑卒中患者接受静脉溶栓治疗244例,NIHSS评分<7分的患者与NIHSS评分≥7分患者相比,颅内出血发生率(分别为2.6%、19.4%;x2=12.466,P<0.01)、7d病死率(分别为1.3%、16.9%;x2=12.308,P<0.01)及3个月病死率(分别为3.8%、21.1%;x2=11.993,P<0.01)更低,而3个月良好预后比例更高(分别为78.2%、38.0%;x2 =34.403,P<0.01).结论 排除溶栓禁忌后,时间窗内到达华山医院的急性缺血性脑卒中患者阿替普酶静脉溶栓率54.6%.年龄、基线NIHSS评分、肢体无力、偏瘫、面瘫和言语症状等因素影响患者静脉溶栓治疗依从性.轻症缺血性卒中患者静脉溶栓治疗的有效性高,安全性好.
目的 明確華山醫院神經內科急性缺血性腦卒中患者阿替普酶靜脈溶栓治療率,分析影響患者靜脈溶栓治療依從性的相關因素.方法 前瞻性連續收集2014年1-12月華山醫院神經內科急診疑似急性腦卒中和短暫性腦缺血髮作患者,排除禁忌證後,按照是否溶栓治療分組比較,尋找影響患者溶栓治療依從性的相關因素.結果 2014年1-12月華山醫院溶栓糰隊急診評估患者共220例,排除禁忌證後,43例患者拒絕溶栓,59例接受溶栓治療.在兩組患者中影響患者是否接受溶栓治療的單因素分析結果顯示,年齡、基線NIHSS評分、肢體無力、偏癱、麵癱或言語癥狀差異有統計學意義(U=936.000,P=0.024;U=284.500,P<0.01;x2=8.824,P=0.003;x2=7.732,P=0.005;x2=5.169,P=0.038;x2 =5.040,P=0.025).受試者工作特徵麯線分析顯示基線NIHSS評分與患者是否接受溶栓治療有關,基線NIHSS評分<7分時,患者拒絕溶栓(敏感度0.93,特異度0.71).進一步分析2008年1月至2014年12月華山醫院急性缺血性腦卒中患者接受靜脈溶栓治療244例,NIHSS評分<7分的患者與NIHSS評分≥7分患者相比,顱內齣血髮生率(分彆為2.6%、19.4%;x2=12.466,P<0.01)、7d病死率(分彆為1.3%、16.9%;x2=12.308,P<0.01)及3箇月病死率(分彆為3.8%、21.1%;x2=11.993,P<0.01)更低,而3箇月良好預後比例更高(分彆為78.2%、38.0%;x2 =34.403,P<0.01).結論 排除溶栓禁忌後,時間窗內到達華山醫院的急性缺血性腦卒中患者阿替普酶靜脈溶栓率54.6%.年齡、基線NIHSS評分、肢體無力、偏癱、麵癱和言語癥狀等因素影響患者靜脈溶栓治療依從性.輕癥缺血性卒中患者靜脈溶栓治療的有效性高,安全性好.
목적 명학화산의원신경내과급성결혈성뇌졸중환자아체보매정맥용전치료솔,분석영향환자정맥용전치료의종성적상관인소.방법 전첨성련속수집2014년1-12월화산의원신경내과급진의사급성뇌졸중화단잠성뇌결혈발작환자,배제금기증후,안조시부용전치료분조비교,심조영향환자용전치료의종성적상관인소.결과 2014년1-12월화산의원용전단대급진평고환자공220례,배제금기증후,43례환자거절용전,59례접수용전치료.재량조환자중영향환자시부접수용전치료적단인소분석결과현시,년령、기선NIHSS평분、지체무력、편탄、면탄혹언어증상차이유통계학의의(U=936.000,P=0.024;U=284.500,P<0.01;x2=8.824,P=0.003;x2=7.732,P=0.005;x2=5.169,P=0.038;x2 =5.040,P=0.025).수시자공작특정곡선분석현시기선NIHSS평분여환자시부접수용전치료유관,기선NIHSS평분<7분시,환자거절용전(민감도0.93,특이도0.71).진일보분석2008년1월지2014년12월화산의원급성결혈성뇌졸중환자접수정맥용전치료244례,NIHSS평분<7분적환자여NIHSS평분≥7분환자상비,로내출혈발생솔(분별위2.6%、19.4%;x2=12.466,P<0.01)、7d병사솔(분별위1.3%、16.9%;x2=12.308,P<0.01)급3개월병사솔(분별위3.8%、21.1%;x2=11.993,P<0.01)경저,이3개월량호예후비례경고(분별위78.2%、38.0%;x2 =34.403,P<0.01).결론 배제용전금기후,시간창내도체화산의원적급성결혈성뇌졸중환자아체보매정맥용전솔54.6%.년령、기선NIHSS평분、지체무력、편탄、면탄화언어증상등인소영향환자정맥용전치료의종성.경증결혈성졸중환자정맥용전치료적유효성고,안전성호.
Objective To clarify the intravenous thrombolysis utilization of acute ischemic stroke patients in Huashan hospital,and to analyze the factors affecting thrombolytic therapy compliance.Methods The data from a prospective cohort were analyzed.Consecutive acute stroke and transient ischemic attack patients from Huashan Hospital emergency room were recruited in 2014.Eligible ischemic stroke patients were divided into two groups according to intravenous thrombolysis or not.Results Totally 220 patients from emergency room were assessed in 2014.Among eligible patients,43 patients refused intravenous thrombolysis,whereas 59 patients chose this therapy.After multiple analysis,age,baseline NIHSS score,limb weakness,hemiplegic paralysis,facial paralysis or speech symptoms were significantly different between the two groups (U =936.000,P =0.024;U =284.500,P < 0.01;x2 =8.824,P =0.003;x2 =7.732,P=0.005;x2 =5.169,P=0.038;x2 =5.040,P=0.025).Patients with NIHSS score <7 tended to refuse thrombolysis therapy in the receiver operating characteristic curve analysis (sensitivity 0.93,specificity 0.71).From 2008 to 2014,244 cases were analyzed in the thrombolysis database.Compared with patients with higher baseline NIHSS score,intracranial hemorrhage rate (2.6% vs 19.4%;x2 =12.466,P <0.01),7-day mortality rate (1.3% vs 16.9%;x2 =12.308,P <0.01) and 3-month mortality rate (3.8% vs 21.1%;x2 =11.993,P <0.01) were lower in patients whose baseline NIHSS score < 7 (minor group).A higher rate of excellent outcome (3-month modified Rankin Scale score ≤ 1)was observed in minor group (78.2% vs 38.0%;x2 =34.403,P < 0.01).Conclusions Intravenous thrombolysis was performed in 54.6% of eligible ischemic stroke patients.Age,baseline NIHSS score,limb weakness,hemiplegic paralysis,facial paralysis or speech symptoms were associated with patients' decision of thrombolysis.The effectiveness and safety of intravenous thrombolysis were promising for patients with mild stroke.