| Objective: Through retrospective investigation,we can understand the early efficacy of intravenous thrombolytic therapy in patients with acute cerebral infarction in a top three hospital in Qiqihar City,and analyze the influencing factors of early curative effect,clarify the influencing factors and make corresponding suggestions,so as to treat acute brain for intravenous thrombolysis.Infarction provides a reference and basis.Methods: According to the "Guidelines for the diagnosis and treatment of acute ischemic stroke in China 2014" and the "Guidelines for the diagnosis and treatment of acute ischemic stroke in 2017",the inclusion and exclusion criteria were formulated.From January 2017 to December 2017,Qiqihar was accepted.In the Department of Neurology,a hospital in the top three hospitals,119 patients who had been diagnosed with acute cerebral infarction and received rt-PA intravenous thrombolytic therapy were included in the study.Collect relevant clinical data of patients with acute cerebral infarction,including age,gender,weight,drinking history,smoking history,history of hyperlipemia,history of hypertension,history of diabetes,history of stroke,family history,history of myocardial infarction,history of atrial fibrillation,admission Blood pressure,admission to blood glucose levels,admission to glycosylated hemoglobin,hospitalized fibrinogen,admission to low-density lipoprotein cholesterol(LDL-C),admission to homo-halophilic levels,rt-PA use,and onset to thrombolysis interval(OTT)And the National Institutes of Health Stroke Scale(NIHSS)scores(hereinafter referred to as NIHSS scores)at 24 hours,3 days,and 7 days after thrombolysis.According to the NIHSS score at the time of admission to patients with acute cerebral infarction,the difference of NIHSS scores at 24 hours,3rd day,and 7th day after thrombolysis decreased by ≥4 points or the complete disappearance of neurological deficit symptoms was considered early effective,and the rest were considered invalid.Patients were divided into an effective group(with a difference of ≥ 4 points from the NIHSS score at admission)and an ineffective group(a decrease of <4 points from the NIHSS score at admission or a difference of ≥4 points from the NIHSS score at admission).The influencing factors affecting the early efficacy of alteplase thrombolysis were determined by t test,χ2 test and logistic regression analysis.Results: 1.Number of valid and ineffective cases at 24 hours,3 days,and 7 days after thrombolysis: A total of 119 patients were enrolled,including 80 males and 39 females;the mean age was(61.96±10.21)years;the effective 24 hours after thrombolysis(the difference between NIHSS scores at admission and ≥4 points)was In 22 cases(18.49%),the number of cases(ineffective with the NIHSS score decreased by <4 points or increased,death)was 97 cases(81.51%);the number of cumulative cases on the third day after thrombolysis was 48 cases(40.34%),the number of invalid cases was 71 cases(59.66%);the number of effective cases on the 7th day after thrombolysis was 54 cases(45.38%),and the number of invalid cases was 65 cases(54.62%).Among them,1 case(0.84%)died in 24 hours,and 3 cases(2.52%)died on the 3rd day after thrombolysis.The cumulative death on the 7th day after thrombolysis was 3(2.52%).2.In patients with acute cerebral infarction,24 hours after intravenous thrombolytic therapy with alteplase,the effective group was compared with the ineffective group: The analysis revealed that the patient’s age,gender,weight,drinking history,smoking history,history of hyperlipidemia,history of hypertension,history of diabetes,history of stroke,family history,history of myocardial infarction,admission blood pressure,admission of glycosylated hemoglobin,admission to fibrinogen Admission to low-density lipoprotein cholesterol(LDL-C),admission to homo-fetatypic level,rt-PA dose,there was no statistically significant difference in neurological function after intravenous thrombolysis for 24 hours,but a history of atrial fibrillation,admission Blood glucose and OTT had an effect on the improvement of early neurological function after intravenous thrombolysis of alteplase for 24 hours.The results showed that the proportion of atrial fibrillation(4.55%)was significantly lower than that of the ineffective group(34.02%);The mean blood glucose level(6.55±2.30mmol/L)was significantly lower than that of the ineffective group(7.02±3.08 mmol/L);the OTT average of the effective group(3.82±0.73 hours)was significantly smaller than the OTT average of the ineffective group(3.70±1.09 hours).),the data of the three groups were statistically different(P<0.05),and the logistic regression analysis showed that the history of atrial fibrillation,admission to blood glucose,and OTT were independent effects of neurological improvement in patients 24 hours after thrombolysis.3.After 3 days after intravenous thrombolysis with alteplase in patients with acute cerebral infarction,the effective group was compared with the ineffective group: According to the analysis,NIHSS score,admission blood glucose and OTT were the influencing factors of early neurological improvement after 3 days of intravenous thrombolytic therapy with alteplase.Among them,the average blood glucose level of the effective group(6.56±2.52mmol/L)was significantly lower than that of the ineffective group(7.18±3.20mmol/L);the effective group OTT average(3.63±0.96 hours)was significantly smaller than the ineffective group(3.79±1.08 hours);the effective rate of the NIHSS score in the moderate group compared with the mild group and the severe group at the time of admission,the effective rate of the NIHSS score moderate group(81.25%)was significantly higher than that of the mild group(4.17%).)and severe group(14.58%),and the data of the two groups were statistically different(P<0.05).After logistic regression analysis,NIHSS score,admission to blood glucose,and OTT at admission were also independent factors influencing the early efficacy of 3 days after thrombolysis.In addition,age,sex,weight,drinking history,smoking history,history of hyperlipidemia,history of hypertension,history of diabetes,history of stroke,family history,history of myocardial infarction,admission blood pressure,admission of glycosylated hemoglobin,admission to fibrinogen There were no significant differences in the doses of rt-PA between admission to low-density lipoprotein cholesterol(LDL-C)and admission to homo-feta.4.After 7 days after intravenous thrombolysis with alteplase in patients with acute cerebral infarction,the effective group was compared with the ineffective group: After analysis,NIHSS score and OTT were the influencing factors of early efficacy after 7 days of intravenous thrombolytic therapy with alteplase;the effective OTT mean(3.63±0.92 hours)was significantly smaller than the ineffective group(3.90±1.12 hours);effective group At the time of admission,the NIHSS score moderate group was significantly more effective than the mild group and the severe group.The effective rate of the NIHSS score in the moderate group(81.48%)was significantly higher than that in the mild group(3.70%)and the severe group(14.80%).And the statistical results were statistically different(P<0.05).Logistic regression analysis showed that the NIHSS score and OTT at admission were also independent factors in the early efficacy of alteplase after 7 days of intravenous thrombolysis.In addition,age,sex,weight,drinking history,smoking history,history of hyperlipidemia,history of hypertension,history of diabetes,history of stroke,family history,history of atrial fibrillation,history of myocardial infarction,admission blood pressure,admission to blood glucose,admission Glycated hemoglobin,hospitalized fibrinogen,hospitalized low-density lipoprotein cholesterol(LDL-C),admission to homotypic de-naphthine levels,and rt-PA doses were not statistically different.conclusions: 1.OTT is an independent influencing factor for the improvement of neurological function in the early stage of rt-PA intravenous thrombolysis(24 hours,3 days,7 days).2.The history of atrial fibrillation is an independent influencing factor for the improvement of neurological function in the early stage of rt-PA intravenous thrombolysis(24 hours),but it is not the influencing factor of the early 3 days and 7 days after thrombolysis.3.Admission to blood glucose was an independent influencing factor for the improvement of neurological function in the early(24 hours,3 days)after rt-PA intravenous thrombolysis.4.The NIHSS score at admission was an independent factor in the improvement of neurological function in the early(3 days,7 days)after rt-PA intravenous thrombolysis. |
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