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目的探讨急性脑梗死患者静脉溶栓后早期神经功能改善及病情变化的影响因素。方法回顾性分析128例急性脑梗死静脉溶栓患者的临床资料,静脉溶栓后24 h及7 d,根据美国国立卫生研究院卒中量表(NIHSS评分)改善≥40%或NIHSS评分0~1分视为溶栓显效,比较显效组和非显效组患者的年龄、性别、高血压病史、糖尿病病史、溶栓时间窗、溶栓前血小板、血糖、血脂、溶栓前NIHSS评分等因素,应用logistic回归分析以上因素与静脉溶栓后早期功能改善及病情变化的关系。结果静脉溶栓后24 h显效率为39.1%,溶栓时间窗是溶栓显效的独立影响因素(OR=2.876,95%CI:1.096~7.542,P=0.032)。溶栓后7 d显效率为53.1%,溶栓时间窗(OR=2.516,95%CI:1.025~6.179,P=0.044),溶栓前NIHSS评分(OR=1.144,95%CI:1.056~1.239,P=0.001),溶栓前血糖(OR=1.149,95%CI:1.034~1.288,P=0.010)是溶栓效果的独立影响因素。结论溶栓时间窗≤3 h、基线NIHSS评分<8分、基线血糖≤7.8 mmol/L对静脉溶栓后早期神经功能改善有益,后两者为影响溶栓后早期病情变化的因素。
Objective To investigate the influencing factors of early neurological function improvement and condition changes after intravenous thrombolysis in patients with acute cerebral infarction. Methods The clinical data of 128 patients with acute cerebral infarction received intravenous thrombolysis were retrospectively analyzed. The improvement of ≥40% or NIHSS score 0 ~ 1 according to National Institutes of Health Stroke Scale (NIHSS score) at 24 h and 7 d after intravenous thrombolysis was retrospectively analyzed. The factors such as age, gender, history of hypertension, history of diabetes mellitus, thrombolytic time window, platelet before thrombolysis, blood glucose, lipids, NIHSS score before thrombolysis were compared between the two groups. Logistic regression analysis of the above factors and venous thrombolysis early functional improvement and the relationship between the changes. Results The effective rate at 24 h after intravenous thrombolysis was 39.1%. The thrombolytic time window was an independent factor influencing thrombolysis (OR = 2.876, 95% CI: 1.096-7.542, P = 0.032). The effective rate of thrombolysis was 53.1% at 7 days after thrombolysis. The time of thrombolysis (OR = 2.516, 95% CI: 1.025 ~ 6.179, P = 0.044) , P = 0.001). The blood glucose before thrombolysis (OR = 1.149, 95% CI: 1.034-1.288, P = 0.010) was an independent factor influencing the thrombolytic effect. Conclusions The time of thrombolysis ≤ 3 h, the baseline NIHSS score <8 and the baseline blood glucose ≤ 7.8 mmol / L are beneficial for the improvement of early neurological function after intravenous thrombolysis. The latter two factors are the factors influencing the early disease after thrombolysis.