Zhai Y, Wang H, Zhan S, Wu H
Department of Internal Medicine, Hospital of Shaanxi Normal University, Xi'an 710062, China.
Department of Neurology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2021 Aug 31;41(9):1426-1430. doi: 10.12122/j.issn.1673-4254.2021.09.20.
To investigate the clinical efficacy and safety of intravenous thrombolysis in patients with acute severe cerebral infarction and analyze the risk factors of poor prognosis after thrombolysis.
This randomized controlled trial was conducted among 152 patients with acute severe cerebral infarction, with the onset time all within 4.5 h. The patients were randomized into control group (76 cases) and observation group (76 cases) and received treatment with routine therapy (antiplatelet aggregation, statins, neuroprotection and drugs that stimulate blood flow) and intravenous thrombolytic therapy with alteplase in addition to the routine therapy, respectively. The NIHSS scores were recorded at 24 h, 1 week and 1 month after the treatment. The mRS scores at 3 months and the incidence of symptomatic intracranial hemorrhage at one week after the treatment were compared between the two groups. According to mRS scores at 3 months, the patients in the observation group were divided into good prognosis group (30 patients) and poor prognosis group (46 patients), and the risk factors for poor prognosis were analyzed using univariate and multivariate Logistic regression analysis.
At 24 h, 1 week and 1 month after the treatment, the reduction of NIHSS scores was more significant in the observation group than in the control group (=24.684, < 0.001). At 3 months after the treatment, the mRS scores were significantly lower =4.396, < 0.001) and the good prognosis rate was significantly higher (χ=13.636, < 0.001) in the observation group than those of the control group. Symptomatic intracranial hemorrhage occurred in 4 cases in the observation group and in 2 cases in the control group within 1 week after the treatment (χ=0.694, =0.405). The time from onset to thrombolysis (OR=0.173, =0.035), prethrombolytic systolic pressure (OR=0.869, =0.019) and baseline NIHSS score (OR=0.466, =0.011) were identified as independent risk factors for poor prognosis after intravenous thrombolysis.
Intravenous thrombolysis is effective and safe for patients with acute severe cerebral infarction, and the time from onset to thrombolysis, prethrombolytic systolic pressure and baseline NIHSS score are independent risk factors for a poor prognosis after intravenous thrombolysis.
探讨急性重症脑梗死患者静脉溶栓的临床疗效及安全性，并分析溶栓后预后不良的危险因素。
本随机对照试验纳入152例急性重症脑梗死患者，发病时间均在4.5小时内。将患者随机分为对照组（76例）和观察组（76例），对照组接受常规治疗（抗血小板聚集、他汀类药物、神经保护及改善脑循环药物），观察组在常规治疗基础上接受阿替普酶静脉溶栓治疗。分别记录治疗后24小时、1周及1个月时的美国国立卫生研究院卒中量表（NIHSS）评分，比较两组治疗后3个月时的改良Rankin量表（mRS）评分及治疗后1周内症状性颅内出血的发生率。根据观察组患者治疗后3个月时的mRS评分，将其分为预后良好组（30例）和预后不良组（46例），采用单因素及多因素Logistic回归分析预后不良的危险因素。
治疗后24小时、1周及1个月时，观察组NIHSS评分降低幅度较对照组更显著（=24.684，<0.001）。治疗后3个月时，观察组mRS评分显著低于对照组（=4.396，<0.001），预后良好率显著高于对照组（χ=13.636，<0.001）。治疗后1周内，观察组有4例发生症状性颅内出血，对照组有2例（χ=0.694，=0.405）。发病至溶栓时间（OR=0.173，=0.035）、溶栓前收缩压（OR=0.869，=0.019）及基线NIHSS评分（OR=0.466，=0.011）被确定为静脉溶栓后预后不良的独立危险因素。
静脉溶栓治疗急性重症脑梗死患者有效且安全，发病至溶栓时间、溶栓前收缩压及基线NIHSS评分是静脉溶栓后预后不良的独立危险因素。
