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  • 黄石仁,沈红健,邢鹏飞,沈芳,张永巍,吴涛,邓本强*.静脉溶栓治疗后不明原因早期神经功能恶化相关因素和临床特征分析[J].第二军医大学学报,2018,39(9):1023-1027    [点击复制]
  • HUANG Shi-ren,SHEN Hong-jian,XING Peng-fei,SHEN Fang,ZHANG Yong-wei,WU Tao,DENG Ben-qiang*.Related factors and clinical feature analysis of unexplained early neurological deterioration after intravenous thrombolysis[J].Acad J Sec Mil Med Univ,2018,39(9):1023-1027   [点击复制]
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静脉溶栓治疗后不明原因早期神经功能恶化相关因素和临床特征分析
黄石仁,沈红健,邢鹏飞,沈芳,张永巍,吴涛,邓本强*
0
(海军军医大学(第二军医大学)长海医院脑血管病中心, 上海 200433
*通信作者)
摘要:
目的 探讨急性缺血性脑卒中(AIS)患者行静脉溶栓治疗后不明原因早期神经功能恶化(END)的相关因素及临床特征。方法 纳入2016年1月至2018年2月于我院脑血管病中心连续登记的发病4.5 h内接受单纯重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的AIS患者。不明原因END定义为发病24 h内美国国立卫生研究院卒中量表(NIHSS)评分较基线增加≥4分,且影像学检查未发现确切机制。比较不明原因END与无END AIS患者的一般资料和治疗前临床数据,同时分析不明原因END AIS患者的临床特征。结果 纳入患者258例,其中无END患者243例(94.2%),不明原因END患者15例(5.8%)。相比无END患者,不明原因END患者中糖尿病比例高,入院至静脉溶栓时间(DNT)长,差异均有统计学意义(χ2=6.093,P=0.048;Z=2.055,P=0.040)。15例不明原因END患者溶栓前NIHSS评分较低[5(4,9)分],急性脑卒中Org 10172治疗试验(TOAST)分型以小动脉闭塞最多(11例,73.3%),梗死部位以内囊后肢(6例,40.0%)和脑桥腹内侧(6例,40.0%)最多。结论 糖尿病、DNT延长可能是AIS患者静脉溶栓治疗后发生不明原因END的危险因素。不明原因END常见于小动脉闭塞AIS,NIHSS评分较低,梗死部位主要为内囊后肢和脑桥腹内侧。
关键词:  急性缺血性脑卒中  早期神经功能恶化  静脉溶栓疗法  危险因素
DOI:10.16781/j.0258-879x.2018.09.1023
投稿时间:2018-07-27修订日期:2018-08-31
基金项目:国家自然科学基金(31370810,30973102,81501008),上海市科委医学引导项目(124119a8900).
Related factors and clinical feature analysis of unexplained early neurological deterioration after intravenous thrombolysis
HUANG Shi-ren,SHEN Hong-jian,XING Peng-fei,SHEN Fang,ZHANG Yong-wei,WU Tao,DENG Ben-qiang*
(Stroke Center, Changhai Hospital, Navy Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author)
Abstract:
Objective To investigate the related factors and clinical features of unexplained early neurological deterioration (END) of acute ischemic stroke (AIS) patients after intravenous thrombolysis. Methods A total of 258 AIS patients, who underwent intravenous thrombolysis treatment within 4.5 h of onset and were registered continuously in Stroke Center of our hospital between Jan. 2016 and Feb. 2018, were included in this study. The unexplained END was defined as the National Institutes of Health stroke scale (NIHSS) score increasing by more than 4 within 24 h of onset compared with that before thrombolysis, with no definite mechanism by imaging examination. The baseline and clinical data were compared between the unexplained END and non-END patients. The clinical features of the AIS patients with unexplained END were analyzed. Results Among the 258 patients enrolled in this study, 243 (94.2%) had no END and 15 (5.8%) had unexplained END. Compared with the patients without END, the proportion of diabetes mellitus in the patients with unexplained END was significantly higher and the door-to-needle time (DNT) was significantly longer (χ2=6.093, P=0.048; Z=2.055, P=0.040). The NIHSS score of 15 patients with unexplained END before thrombolysis was low (5[4, 9]). The most common type of trial of Org 10172 in Acute Stroke Treatment (TOAST) classification was small artery occlusion (11 cases, 73.3%). The most common infarction sites were posterior limb of internal capsule (6 cases, 40.0%) and ventromedial pons (6 cases, 40.0%). Conclusion Diabetes mellitus and long DNT may be the risk factors of unexplained END in the patients with AIS after intravenous thrombolysis. Unexplained END usually occurs in the AIS patinets with small artery occlusion and has lower NIHSS score; the common sites of infarction are posterior limb of the internal capsule and ventromedial pons.
Key words:  acute ischemic stroke  early neurological deterioration  intravenous thrombolytic therapy  risk factors