MRI指导下轻中度脑梗死超时间窗静脉溶栓预后的影响因素分析.docVIP

MRI指导下轻中度脑梗死超时间窗静脉溶栓预后的影响因素分析 　　摘 要 目的：探讨影响轻、中度急性脑梗死超时间窗rt-PA静脉溶栓预后的危险因素。方法：收集发病4.5～12 h内轻、中度脑梗死（NIHSS评分≤15分）193例，MRI评价存在缺血半暗带47例，通过比较预后良好组和不良组之间的临床资料，分析影响预后的独立危险因素。结果：超时间窗溶栓47例病人中，多因素回归分析显示溶栓预后好与NIHSS评分低（OR 1.652，95%CI 1.391～3.814）、发病-给药时间短（OR 0.968，95%CI 0.841～0.998）、溶栓前基础血糖低（OR 2.010，95%CI 2.107～4.269）显著相关。NIHSS评分和发病-溶栓时间关系散点图揭示：超时间窗共47例病人中，预后良好38例，其中4.5～6 h占29例（76.32%），6～12 h占 9例且NIHSS评分≤7分;预后不良9例，其中有6例（66.67%）集中分布在6～12 h且NIHSS评分≥7分。结论：超时间窗患者溶栓前NIHSS评分低、血糖低、发病-溶栓时间短预后好，发病-溶栓时间越长，需要NIHSS较低，溶栓才可能获益。 　　关键词 急性缺血性卒中 磁共振成像 血栓溶解疗法 预后 Logistic回归 　　中图分类号：R743.33 文献标识码：A 文章编号：1006-1533（2015）05-0018-06 　　The effect of MRI-based intravenous thrombolysis with recombinant tissue plasminogen activator on the prognosis of patients with mild-and-moderate 　　acute cerebral infarction and broadened therapeutic window* 　　CHEN Cuirong1，2， BAI Qingke2， ZHAO Zhenguo3， SUI Haijing3， HUANG Jing1** 　　（1. Department of Neurology， Shanghai Tenth People’s Hospital affiliated to Tongji University， Shanghai 200072， China; 　　2. Department of Neurology， the People’s Hospital of Pudong New District， Shanghai 201299， China; 　　3. Department of Radiology， the People’s Hospital of Pudong New District， Shanghai 201299， China） 　　ABSTRACT Objective： To investigate the risk factors of intravenous thrombolysis with recombinant tissue plasminogen activator（rt-PA）in the prognosis of patients with mild-and-moderate acute cerebral infarction and broadened therapeutic window. Methods： One hundred and ninety-three cases of patients were primarily screened， who were diagnosed as mild-and-moderate cerebral infarction （NIHSS score ≤15 points） within 4.5～12 hours of acute stroke symptom onset. Clinical data between good and poor prognosis were compared in 47 cases with ischemic penumbra confirmed by brain MRI scanning and the independent factors affecting prognosis were analyzed. Results： Logistic regression analysis showed that the good prognosis of thrombolysis