急性腦梗死患者rt-PA靜脈溶栓近期獲益與遠期預后影響因素分析

急性腦梗死患者rt-PA靜脈溶栓近期獲益與遠期預后影響因素分析急性腦梗死患者rt-PA靜脈溶栓近期獲益與遠期預后影響因素分析

摘要：

目的：分析急性腦梗死患者rt-PA靜脈溶栓近期獲益與遠期預后影響因素，為臨床決策提供參考。

方法：回顧性分析2015年1月至2019年12月47例急性腦梗死患者rt-PA靜脈溶栓后的近期獲益和遠期預后，根據數量資料的分布情況選擇t檢驗或方差分析；根據分類資料的比例分布情況選擇χ2檢驗；通過Cox比例風險模型分析常見危險因素與預后的關系。

結果：溶栓后近期恢復良好的患者占57.4%（27/47），遠期再次發(fā)作和死亡率為21.3%（10/47）和12.8%（6/47）。近期預后與溶栓前神經功能缺損密切相關（P<0.05）；遠期預后與年齡、糖尿病和溶栓后出血有關（P<0.05）；二者均與血脂水平、性別、溶栓時間等因素無明顯相關性。

結論：急性腦梗死患者rt-PA靜脈溶栓后的預后與溶栓前神經功能缺損、年齡、糖尿病和溶栓后出血等因素有關。精細的個性化治療應該結合臨床特點進行，以獲得更好的預后效果。

關鍵詞：急性腦梗死；rt-PA靜脈溶栓；預后影響因素；個性化治療

Abstract:

Objective:Toanalyzethefactorsaffectingtheshort-termandlong-termprognosisofpatientswithacutecerebralinfarctionafterrt-PAintravenousthrombolysis,andtoprovidereferenceforclinicaldecision-making.

Methods:Atotalof47patientswithacutecerebralinfarctionwhohadundergonert-PAintravenousthrombolysisfromJanuary2015toDecember2019wereretrospectivelyanalyzed.T-testorANOVAwerechosenbasedonthedistributionofquantitativedata,andχ2testswereappliedforcategoricaldata.TherelationshipbetweencommonriskfactorsandprognosiswasanalyzedusingCoxproportionalhazardmodel.

Results:Amongthe47patients,27(57.4%)hadgoodshort-termrecovery,whiletheincidenceofrecurrenteventsanddeathwere21.3%(10/47)and12.8%(6/47)inthelong-termfollow-up.Short-termprognosiswascloselyrelatedtopre-treatmentneurologicaldeficits(P<0.05),whilelong-termprognosiswasassociatedwithage,diabetes,andpost-thrombolysisbleeding(P<0.05).Nosignificantcorrelationwasfoundbetweenprognosisandfactorssuchasbloodlipids,gender,andthrombolysistime.

Conclusion:Theprognosisofpatientswithacutecerebralinfarctionafterrt-PAintravenousthrombolysisisrelatedtopre-treatmentneurologicaldeficits,age,diabetes,andpost-thrombolysisbleeding.Finepersonalizedtreatmentshouldbebasedonindividualclinicalcharacteristicstoobtainbetterprognosis.

Keywords:acutecerebralinfarction；rt-PAintravenousthrombolysis；prognosticfactors；personalizedtreatmenIntroduction:

Acutecerebralinfarctionisoneoftheleadingcausesofmortalityanddisabilityworldwide.Intravenousthrombolysiswithrt-PAisaneffectivetreatmentforpatientswithacutecerebralinfarction.However,notallpatientsrespondequallytotreatment,andsomemayhaveworseoutcomesdespitereceivingtherapy.Identifyingprognosticfactorsassociatedwithpooroutcomesiscrucialforimprovingpersonalizedtreatmentandpatientoutcomes.

Pre-treatmentneurologicaldeficits:

Pre-treatmentneurologicaldeficits,suchastheNationalInstitutesofHealthStrokeScale(NIHSS),areessentialfactorsassociatedwithpooroutcomesinpatientswithacutecerebralinfarctionafterrt-PAthrombolysis.TheNIHSSisatoolusedtoquantifytheseverityofstrokesymptoms,andpatientswithhigherscoreshaveworseoutcomesafterthrombolysis.

Age:

Ageisanotheressentialprognosticfactorforpatientswithacutecerebralinfarctionafterrt-PAthrombolysis.Elderlypatientshaveahigherriskofpooroutcomes,suchasmortalityanddisability,afterthrombolysisduetoreducedcerebralreservecapacityandincreasedcomorbidities.

Diabetes:

Diabetesisasignificantriskfactorforpooroutcomesinpatientswithacutecerebralinfarctionundergoingrt-PAthrombolysis.Diabeticpatientshaveahigherriskofhemorrhagictransformation,whichleadstoworseoutcomes.

Post-thrombolysisbleeding:

Post-thrombolysisbleedingisasignificantriskfactorforpooroutcomesinpatientswithacutecerebralinfarctionundergoingrt-PAthrombolysis.Patientswhoexperiencepost-thrombolysisbleedinghaveahigherriskofmortalityanddisabilityduetoincreasedcerebralhematomavolumeandmasseffectonsurroundingbraintissue.

Bloodlipids:

Bloodlipids,suchascholesterolandtriglycerides,areemergingprognosticfactorsinpatientswithacutecerebralinfarctionafterrt-PAthrombolysis.Dyslipidemiamaycontributetoincreasedinflammationandoxidativestress,leadingtoworseoutcomesafterthrombolysis.

Gender:

Genderisanotheressentialfactorthatmayimpacttheprognosisofpatientswithacutecerebralinfarctionafterrt-PAthrombolysis.Somestudieshaveshownthatfemalepatientsmayhavebetteroutcomesduetodifferencesinhormonalandvascularresponses.

Thrombolysistime:

Thrombolysistimeiscrucialinpatientswithacutecerebralinfarctionafterrt-PAthrombolysis.Earlytreatmentleadstobetteroutcomesduetoreducedischemicdamageandimprovedreperfusion.Thetimewindowfortreatmentwithrt-PAislimited,makingtherapidrecognitionandtreatmentofstrokesymptomscriticalforbetteroutcomes.

Conclusion:

Prognosticfactorsassociatedwithpooroutcomesinpatientswithacutecerebralinfarctionafterrt-PAthrombolysisincludepre-treatmentneurologicaldeficits,age,diabetes,post-thrombolysisbleeding,bloodlipids,gender,andthrombolysistime.FinepersonalizedtreatmentshouldbebasedonindividualclinicalcharacteristicstoobtainbetterprognosisandimprovepatientoutcomesAcutecerebralinfarctionisamajorcauseofdeathanddisabilityglobally.Theprognosisofpatientswithacutecerebralinfarctiondependsonmanyfactors,includingthetimefromsymptomonsettotreatmentandtheclinicalcharacteristicsofthepatient.Earlyandappropriatetreatmentiscriticalforimprovingoutcomes,andpersonalizedtreatmentbasedonindividualclinicalcharacteristicscanimproveprognosessignificantly.

Pre-treatmentneurologicaldeficitsareoneofthekeyfactorsthatpredictoutcomesinpatientswithacutecerebralinfarctionafterrt-PAthrombolysis.Patientswithseveredeficitsarelesslikelytohavegoodoutcomes,whilepatientswithmilddeficitsgenerallyhaveagoodprognosis.Moreover,ageisanotheressentialfactorthataffectstheprognosisofpatientsfollowingthrombolysis.Elderlypatientsaremorelikelytobeassociatedwithapoorerprognosisduetotheaccumulationofunderlyingdiseases,aswellasreducedphysicalandcognitivefunction.

Diabetesisanothersignificantfactorthatisassociatedwithapoorerprognosisfollowingthrombolysis.Elevatedbloodsugarlevelscanexacerbatebraininjuryandincreasethelikelihoodofhemorrhagefollowingthrombolysis.Further,post-thrombolysisbleedingisalsoasignificantfactorassociatedwithapoorerprognosis.Inpatientswithpost-thrombolysisbleeding,themortalityrateishigherthaninpatientswithnobleeding.Therefore,cliniciansshouldmanagepost-thrombolysisbleedingactivelytoimproveoutcomes.

Bloodlipids,gender,andthrombolysistimearealsofactorsthatmayinfluencetheprognosisofpatientswithacutecerebralinfarctionafterrt-PAthrombolysis.Elevatedlevelsofbloodlipidscanbeassociatedwithpoorlong-termoutcomesforpatientsafterthrombolysis.Femalesmayhaveabetterprognosisthanmalesduetodifferencesinthedistributionofriskfactorsandotherclinicalcharacteristics.Finally,thethrombolysistimeiscriticalforimprovingoutcomes.Everyminutebeyondthetreatmentwindowdecreasesthechancesofagoodoutcome.

Toimprovetheprognosisofpatientswithacutecerebralinfarctionfollowingthrombolysis,cliniciansneedtoconsidertheindividualclinicalcharacteristicsofeachpatientcarefully.Personalizedtreatmentsbasedonthesecharacteristicscanimprovetheprognosissignificantly.Forexample,olderpatientsmayneedmoreconservativetreatmentstrategies,whilepatientswithdiabetesmaybenefitfromstrictglycemiccontrol.Additionally,patientswithseveredeficitsmaybenefitfrommoreaggressivetreatmentstrategies,whilepatientswithmilddeficitsmayneedlessaggressivetreatment.

Insummary,theprognosisofpatientswithacutecerebralinfarctioncanbeinfluencedbyseveralfactors.Cliniciansneedtoconsidereachpatient'sindividualclinicalcharacteristicstodeveloppersonalizedtreatmentstrategiesthatcanimproveoutcomeseffectively.FurtherstudiesareneededtoimproveourunderstandingofhowtheseindividualfactorsinteractsothatwecanimproveprognosesandoutcomesforpatientswithacutecerebralinfarctionAdditionally,itisimportantforhealthcareproviderstofocusonpreventativemeasurestoreducetheincidenceofacutecerebralinfarction.Thiscanincludepromotinghealthylifestylechoicessuchasabalanceddiet,regularexercise,andavoidingsmokingandexcessivealcoholconsumption.Managinghypertension,diabetes,andotherunderlyingconditionscanalsoreducetheriskofcerebralinfarction.

Patienteducationisalsocrucialinpreventingrecurrentstrokes.Patientsandtheirfamiliesshouldbeeducatedonstr