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目的:探讨重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)溶栓治疗急性脑梗死的近期临床疗效及其影响因素。方法:回顾性分析2013年8月至2015年1月于我院神经内科接受rt-PA溶栓治疗的88例急性脑梗死患者的临床资料,分析患者入院及发病24h的美国国立卫生研究院卒中量表(NIHSS)评分,以评分的差值作为结局变量,分为预后良好的观察组(NIHSS差值≥4分或≥50%)及预后不良的对照组(NIHSS差值<4分或<50%)。选取溶栓前临床及实验室资料,筛选不良预后的可能影响因素,并进行单因素及多因素分析。结果:88例患者溶栓治疗后近期预后良好者46例(52.27%),预后不良者42例(47.73%)。4.5 h内接受溶栓者好转率为57.14%(36/63),>4.5 h接受溶栓者好转率为32.00%(8/25),显著低于4.5h内接受溶栓者,差异具有统计学意义(P<0.05)。单因素分析结果显示糖尿病史、高密度脂蛋白、血糖、溶栓时间窗、NIHSS评分变量是影响rt-PA溶栓疗效的因素,进一步多因素分析结果显示溶栓时间窗、血糖、NIHSS评分是影响rt-PA溶栓疗效的因素。结论:rt-PA静脉溶栓治疗急性脑梗死的近期疗效有明显的时间依赖性,且血糖、NIHSS评分为早期预后的影响因素。
Objective: To investigate the short-term clinical efficacy and its influencing factors of recombinant tissue plasminogen activator (rt-PA) for acute cerebral infarction. Methods: The clinical data of 88 patients with acute cerebral infarction who received rt-PA thrombolysis in our department of neurology from August 2013 to January 2015 were retrospectively analyzed. The incidences of NIH Stroke (NIHSS) score, and the differences of the scores were taken as outcome variables and divided into good prognosis group (NIHSS difference≥4 points or≥50%) and poor prognosis control group (NIHSS difference <4 points or < 50%). Select the pre-thrombolytic clinical and laboratory data to screen the possible influencing factors of poor prognosis, and univariate and multivariate analysis. Results: Among 88 patients, 46 cases (52.27%) had good prognosis in the near future and 42 cases (47.73%) had poor prognosis. In 4.5 h, the improvement rate was 57.14% (36/63) in patients receiving thrombolysis, and the improvement rate was 32.00% (8/25) in those receiving> 4.5 h thrombolysis, significantly lower than those receiving thrombolysis within 4.5 h Significance (P <0.05). Univariate analysis showed that history of diabetes mellitus, high density lipoprotein, blood glucose, thrombolytic time window and NIHSS score variables were the factors influencing the efficacy of rt-PA thrombolysis. Further multivariate analysis showed that thrombolysis time window, blood glucose, NIHSS score were Factors influencing rt-PA thrombolysis. Conclusion: The short-term curative effect of intravenous thrombolytic therapy of rt-PA on acute cerebral infarction has obvious time dependence, and the blood sugar and NIHSS scores are the influencing factors of early prognosis.