Factors Influencing The Recent Benefits And Long-term Prognosis Of Intravenous Thrombolysis With Rt-PA In Patients With Acute Cerebral Infarction

Objective In this study,by the evaluation of the short-term benefit and long-term prognosis of rT-PA intravenous thrombolysis in patients with ultra-early acute cerebral infarction（ACI）,the factors influencing the recent benefit and long-term prognosis of the patients were comprehensively analyzed,to provide an important basis for improving the recent and long-term efficacy of the patients with thrombolysis.So as to further guide the clinical ultra-early thrombolysis and clinical treatment 90 days after thrombolysis.Methods A total of 154 patients with ACI who were admitted to the Department of Neurology,Suzhou Hospital of Anhui Medical University from November 2018 to January 2021 after intravenous thrombolytic therapy with rt-PA were enrolled.The recent and long-term efficacy were evaluated respectively.According to the improvement of neurological function 24 hours after thrombolytic therapy,they were divided into the recent-benefical group and the non-recent-benefical group.According to 90dmRS score,the patients were divided into good-long-term prognosis group and poor-long-term prognosis group.General population data,laboratory indicators,NIHSS score before thrombolysis,GCS score on admission,ONT,90dmRS score,TOAST classification,bleeding transformation rate,thrombolysis time,infarct location,etc.At the same time,the blood pressure of patients was monitored to observe the blood pressure variability.Results1.A total of 154 ACI patients were enrolled in this study,including 95 males and 59 females,with an average age of 65.99±13.52,including 108 patients in the recent-benefical group and 46 patients in the non-recent-benefical group.There were 99 cases in the good-long-term prognosis group and 55 cases in the poor-long-term prognosis group.2.The proportion of atrial fibrillation,systolic blood pressure before thrombolysis,NIHSS score before thrombolysis,ONT,bleeding conversion rate,fibrinogen,total cholesterol level and blood glucose before thrombolysis in patients with recent-benefical group were significantly lower than those in patients with non-recen-benefical group;The GCS score was significantly higher than that of the non-recent-benefical group（P<0.05）.And compared with the recent-benefical group,patients in the group with non-recent-benefical were 24hSBP,dSBP,24hSSD,dSSD and nSSD were significantly higher,and the differences were statistically significant（P<0.05）.3.The proportion of atrial fibrillation,systolic blood pressure before thrombolysis,NIHSS score before thrombolysis,ONT,blood flow transformation,fibrinogen level,D-dimer level and blood glucose before thrombolysis in patients with good-long-term prognosis were significantly lower than those in patients with poor-long-term prognosis.Good-long-term prognosis was also related to TOAST classification.There was significant difference（P<0.05）;And compared with the group with good-long-term prognosis,dSBP,nSBP,dSSD,nSSD were significantly higher,and the differences were statistically significant（P<0.05）.4.Systolic blood pressure before thrombolysis,blood glucose before thrombolysis,NIHSS score before thrombolysis,ONT,dSBP and dSSD were independent influencing factors of recent benefit.5.Systolic blood pressure before thrombolysis,blood glucose before thrombolysis,NIHSS score before thrombolysis,TOAST classification,history of atrial fibrillation,dSBP,dSSD was an independent factor influencing long-term prognosis.6.Further ROC curve analysis showed that systolic blood pressure before thrombolytic therapy,blood glucose before thrombolytic therapy,NIHSS score before thrombolytic therapy,dSBP and dSSD had predictive value for recent and long-term prognosis of ACI patients,and dSSD had stronger prognostic ability.Conclusion1.The recent benefit is related to systolic blood pressure,blood glucose,NIHSS score,ONT,dSBP and dSSD before thrombolysis.2.Long-term prognosis was associated with systolic blood pressure before thrombolysis,blood glucose before thrombolysis,NIHSS score before thrombolysis,dSBP,dSSD,TOAST classification and history of atrial fibrillation.3.Systolic blood pressure before thrombolysis,blood glucose before thrombolysis,NIHSS score before thrombolysis,dSBP and dSSD are the common influencing factors of recent benefit and long-term prognosis,and have predictive value for both recent and long-term prognosis,and dSSD has stronger prognostic ability.4.Other factors with statistical significance in the analysis of single factors,such as GCS score,bleeding conversion,fibrinogen level,total cholesterol level,D-dimer level,although not independent influencing factors,can interact and jointly affect the prognosis of patients.5.Strictly controlling the indications of patients before thrombolytic therapy and controlling corresponding risk factors,such as lowering blood glucose and blood pressure before thrombolytic therapy and controlling blood pressure fluctuation smoothly,can effectively improve the prognosis of patients with thrombolytic therapy.