静脉溶栓治疗CE型与LAA型缺血性脑卒中的观察性研究

被引：7

作者：

张伟华 ^{[1
]}

赵广健 ^{[2
]}

董丽丽 ^{[1
]}

张斌升 ^{[1
]}

贾画舫 ^{[1
]}

王自然 ^{[2
]}

韩红星 ^{[1
]}

机构：

[1] 青岛大学第十一临床医学院(临沂市人民医院)神经内科

[2] 青岛大学第十一临床医学院(临沂市人民医院)急诊科

来源：

中华神经医学杂志 | 2019年 / 18卷 / 08期

关键词：

静脉溶栓; 急性缺血性脑卒中; 大动脉粥样硬化型; 心源性栓塞型; 预后;

D O I：

暂无

中图分类号：

R743.3 [急性脑血管疾病（中风）];

学科分类号：

100204 [神经病学];

摘要：

目的比较心源性栓塞(CE)型与大动脉粥样硬化(LAA)型急性前循环缺血性脑卒中患者静脉溶栓的安全性与有效性。方法选择自2017年1月至2018年6月在临沂市人民医院南医疗区急诊科接受静脉溶栓治疗的238例急性前循环缺血性脑卒中患者, 根据TOAST病因学分型分为CE组(n=80)和LAA组(n=158), 比较2组患者基线资料及发病后90 d时预后的差异, 并进一步比较预后良好组患者与预后不良组患者间基线资料的差异及采用多因素Logistic回归分析筛选预后不良的独立危险因素。结果与LAA组相比, CE组患者年龄明显更大, 合并心房颤动者比例明显更高, 差异均有统计学意义(P<0.05), 而2组患者预后良好率、死亡率及症状性颅内出血发生率差异均无统计学意义(P>0.05)。238例患者中预后良好组112例, 预后不良组126例。与预后不良组比较, 预后良好组患者年龄、静脉溶栓前后美国国立卫生研究院卒中量表(NIHSS)评分及空腹血糖水平均明显偏低, 差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示年龄偏大(OR=1.040, 95%CI:1.010～1.071, P=0.008)、静脉溶栓后24 h NIHSS评分高(OR=1.259, 95%CI:1.175～1.350, P=0.000)是预后不良的独立危险因素。结论静脉溶栓治疗急性前循环缺血性脑卒中的预后仅与年龄、脑卒中严重程度有关, 而与TOAST病因学分型无关, CE型患者进行静脉溶栓亦安全有效。

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