摘要
目的研究发病4.5 h内老年急性脑卒中患者不同治疗方式的预后情况及危险因素。方法回顾性分析2018年3月~2020年3月在南通大学附属如皋医院接受治疗的120例急性脑卒中患者,按照其接受治疗方式的不同将其分为静脉溶栓组(65例)和桥接治疗组(55例),静脉溶栓组采取单纯重组组织型纤溶酶原激活剂(rt-PA)溶栓治疗,桥接治疗组在溶栓基础上采取机械取栓。比较两组治疗后美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin(mRS)评分>2分发生比例、颅内出血发生率及死亡率,并以mRS评分>2分作为预后不良将所有患者分为预后良好组及预后不良组。利用ROC分析梗死体积、三酰甘油(TG)水平预测患者治疗后预后不良的价值,将两组有差异信息纳入logistic回归分析模型,进行量化赋值明确引起患者预后不良的危险因素。结果静脉溶栓组NIHSS评分及mRS>2分患者比例显著高于桥接治疗组,差异有统计学意义(P<0.05)。预后不良组年龄≥70岁、单纯静脉溶栓、合并糖尿病、合并卒中家族史、合并房颤患者比例及梗死体积、TG水平显著高于预后良好组,差异有统计学意义(P<0.05)。经ROC分析,梗死体积、TG水平预测患者预后不良的曲线下面积分别为0.761、0.836。经Logistic回归性分析证实,年龄≥70岁、单纯静脉溶栓、合并糖尿病、合并卒中家族史、合并房颤、梗死体积≥69.875 ml、TG≥1.505 mmol/L是脑卒中患者经治疗后预后不良的危险因素。结论溶栓基础上进行桥接治疗有利于老年急性脑卒中患者预后的改善,但还需结合患者年龄、糖尿病、卒中家族史、房颤、梗死体积、TG水平等危险因素进行治疗方案的调整。
Objective To study the prognosis and risk factors of different treatment methods in elderly patients with acute stroke within 4.5 hours after onset.Methods The clinical data of 120 patients with acute stroke treated in our hospital from March 2018 to March 2020 were retrospectively analyzed.According to the different treatment methods,they were randomly divided into intravenous thrombolysis group(n=65)and bridging treatment group(n=55).The intravenous thrombolysis group was treated with recombinant tissue plasminogen activator(rt-PA)thrombolysis alone,and the bridging treatment group was treated with mechanical therapy on the basis of thrombolysis remove the suppository with mechanical device;After treatment,NIHSS score,modified Rankin(MRS)score>2,incidence of intracranial hemorrhage and mortality were compared between the two groups.ROC was used to analyze the value of infarct volume and triglyceride(TG)level in predicting poor prognosis of patients after treatment.The difference information between the two groups was included in the logistic regression analysis model for quantitative evaluation,and the risk factors of poor prognosis of patients were identified.Results The proportion of patients with NIHSS score and Mrs>2 score in the intravenous thrombolysis group was significantly higher than that in the bridging treatment group(P<0.05).The proportion of patients with age≥70 years,Intravenous thrombolysis alone,diabetes mellitus,family history of stroke,atrial fibrillation,infarct volume and TG level in poor prognosis group were significantly higher than those in good prognosis group(P<0.05).ROC analysis showed that the area under the curve of infarct volume and TG level predicting poor prognosis was 0.761 and 0.836,respectively.Logistic regression analysis showed that age≥70 years old,Intravenous thrombolysis alone,diabetes mellitus,family history of stroke,AF,infarct volume≥69.875 ml,TG≥1.505 mmol/L were the risk factors for poor prognosis of stroke patients after treatment.Conclusion Bridge therapy
作者
张亚云
徐培培
高桂香
邹明宏
Zhang Yayun;Xu Peipei;Gao Guixiang(Department of Emergency,Rugao Hospital Affiliated to Nantong University,Nantong 226500,China)
出处
《中华保健医学杂志》
2021年第5期473-476,共4页
Chinese Journal of Health Care and Medicine
基金
南通市市级科技计划项目(MSZ19078)。
