张丽　叶健晓

[摘要] 目的 探討静脉溶栓治疗急性脑梗死预后影响因素。 方法 选择2019年1月至2020年3月在我院治疗的急性脑梗死患者120例的临床资料进行回顾性分析，根据3个月后mRS评分分为预后良好组（n=68）与预后不良组（n=52）。单因素及多因素分析影响患者预后的相关因素。 结果 单因素分析结果显示，与预后良好组比较，预后不良组患者脑梗死面积更大，入院时血糖水平更高，溶栓前NIHSS评分更高，OCSP分型TACI比例更高，TOAST分型LAA型更高，24 h内NIHSS评分改善≥40%比例更低，溶栓后脑出血比例更高，差异均有统计学意义（P<0.05）。多因素分析结果显示，梗死面积、入院时血糖水平、溶栓前NIHSS评分、TACI分型、LAA分型是静脉溶栓治疗急性脑梗死预后不良的独立危险因素（P<0.05），而24 h内NIHSS改善≥40%是保护因素（P<0.05）。 结论 影响静脉溶栓治疗急性脑梗死预后的相关因素中主要有梗死面积、溶栓前NIHSS评分以及临床分型等，而溶栓后短时间NIHSS改善情况是保护因素，可以作为患者溶栓治疗后预后的判断指标。

[关键词] 急性脑梗死;静脉溶栓;NIHSS评分;OCSP分型;TOAST分型;预后

[中图分类号] R743.3          [文献标识码] B          [文章编号] 1673-9701（2021）11-0040-04

Analysis on the impacting factors of prognosis in the treatment of acute cerebral infarction by intravenous thrombolysis

ZHANG Li   YE Jianxiao

Department of Emergency， Lishui Municipal Central Hospital in Zhejiang Province， Lishui   323000， China

[Abstract] Objective To investigate the impacting factors of prognosis in the treatment of acute cerebral infarction by intravenous thrombolysis. Methods The clinical data of 120 cases of patients with acute cerebral infarction treated in our hospital from January 2019 to March 2020 were selected and analyzed retrospectively， and they were divided into the good prognosis group （n=68） and the poor prognosis group （n=52） according to mRS score 3 months after the treatment. Univariate and multivariate analysis were applied in the related factors impacting the prognosis of patients. Results Univariate analysis showed that compared with the good prognosis group，patients in the poor prognosis group were diagnosed as larger cerebral infarction area，higher blood glucose level at admission， higher NIHSS score before thrombolysis，higher proportion with TACI of OCSP subtype， higher proportion with TOAST subtype of LAA type，lower proportion with NIHSS score improvement ≥40% within 24 hours，and higher proportion with cerebral hemorrhage after thrombolysis（P<0.05）. Multivariate analysis showed that the infarct size（IS）， blood glucose level at admission， NIHSS score before thrombolysis， TACI subtype， LAA subtype were independent risk factors of intravenous thrombolysis for poor prognosis of acute cerebral infarction（P<0.05）， while NIHSS score improvement≥40% was a protective factor（P<0.05）. Conclusion The related factors impacting the prognosis of acute cerebral infarction after intravenous thrombolysis mainly include IS，NIHSS score before thrombolysis and clinical subtype，etc. The short-term improvement of NIHSS score after thrombolysis is a protective factor，which can be used as a prognostic index for patients after thrombolytic therapy.

[Key words] Acute cerebral infarction; Intravenous thrombolysis; NIHSS score; OCSP subtype; TOAST subtype; Prognosis

我国第三次国民死因调查显示，我国脑卒中发病率排名世界第一，比美国高一倍，脑卒中已成为中国第一位死因，高于欧美国家[1]。急性脑梗死后的治疗目标应尽早恢复脑血流，改善半暗区的血液供应，缩小梗死面积，挽救未死亡的脑组织及功能。静脉溶栓是急性脑梗死后尽早恢复脑血流的重要方法之一[2]。但即便患者进行静脉溶栓治疗，部分患者难以有效恢复脑血流供应。既往研究显示，溶栓的时间、血栓大小、类型，药物，闭塞的部位等是影响患者溶栓效果的主要因素[3-4]。因此了解影响急性脑梗死患者溶栓治疗预后的相关因素，对临床治疗方案、改善预后等均具有重要的临床意义。急性脑梗死在我院是常见病，并随着急诊工作效率的不断提高，具有静脉溶栓指征的患者也越来越多，为本研究提供了丰富的临床资料，现报道如下。……