Woloszynska Izabela, Stfpien Adam
Acta Pol Pharm. 2017 Jan;74(1):293-298.
The stroke mortality rate in Poland is one of the highest in Europe with particularly large percentage of deaths in early phase of stroke. The aim of the study was to analyze the causes and risk factors for treatment failure and early death in patient with ischemic stoke treated with thrombolysis in the Department of Neurology, Military Institute of Medicine. The study included 295 patients treated with thrombolysis over the period 2005-2015. The study protocol defined for each patient include demographic data, time of recombinant tissue plasminogen activator (rt-PA) administration from the onset of symptoms, the presence of stroke risk factors. The incidence of in-hospital deaths was 8.1% within the first week and 15.6% in the first month. In the final model, relevant death predictors were: baseline National Institutes of Health Stroke Score (NIHSS), hemorrhagic transformation type 2, hyperglycemia at admission and increased blood pressure above 180/110 mmHg during or in the first day after thrombolysis. The most common cause of death was a massive stroke with increased intracranial pressure, (36.4%), intracerebral hemorrhage (15.3%), concomitant edema and hemorrhage (27%), pneumonia (15.3%), cardiac disorders (13.4%). The important risk factors of death directly associated with thrombolytic therapy were hemorrhagic transformation and hemisphere stroke with malignant edema increasing the risk of bleeding.
波兰的中风死亡率是欧洲最高的之一，中风早期死亡的比例尤其高。本研究的目的是分析在军事医学研究所神经科接受溶栓治疗的缺血性中风患者治疗失败和早期死亡的原因及风险因素。该研究纳入了2005年至2015年期间接受溶栓治疗的295例患者。为每位患者定义的研究方案包括人口统计学数据、症状发作后重组组织型纤溶酶原激活剂（rt-PA）给药时间、中风风险因素的存在情况。住院死亡率在第一周为8.1%，在第一个月为15.6%。在最终模型中，相关的死亡预测因素为：基线美国国立卫生研究院卒中量表（NIHSS）评分、2型出血性转化、入院时高血糖以及溶栓期间或溶栓后第一天血压升高超过180/110 mmHg。最常见的死亡原因是颅内压升高的大面积中风（36.4%）、脑出血（15.3%）、伴有水肿和出血（27%）、肺炎（15.3%）、心脏疾病（13.4%）。与溶栓治疗直接相关的重要死亡风险因素是出血性转化和伴有恶性水肿增加出血风险的半球性中风。
