Clinical Study On Influencing Factors Of Efficacy Of Alteplase In Treatment Of Acute Ischemic Stroke

ObjectiveA retrospective and prospective study was conducted to compare the effects of the treatment of acute ischemic stroke in the treatment of thrombolytic thrombolysis.By discussing its correlation with the prognosis of patients,it can provide more help for clinical treatment.MethodsWe selected the clinical data of patients with diagnosed acute ischemic stroke undergoing thrombolytic therapy with alteplase in the Department of Neurology of the First Affiliated Hospital of Chengdu Medical College between January 2015 and December 2017.Their age,gender,severity of stroke before/after thrombolysis(NIHSS score),mean arterial pressure,glycosylated hemoglobin,total cholesterol,high-density lipoprotein,leucocyte count,blood oxygen saturation,body temperature,hemorrhagic transformation,thrombolytic time window,way of thrombolysis and past medical history(atrial fibrillation,oxygen inhalation,stroke,cardiac insufficiency)were recorded.The thrombolytic pathway is limited to intravenous or arterial thrombolysis.Thrombolytic patiants were followed by outpatient or telephone after 90 days.Prognosis was evaluated using the modified Rankin scale(mRS)score after treatment: 0-2,good prognosis;3-6,poor prognosis.ResultsA total of 64 patients undergoing thrombolytic therapy with alteplase were included in this study,including 34 males(54.6%)and 29 females(45.4%),with a median age of 69 years and an interquartile range of 10.5 years.Among the 64 patients,29(45.3%)patients showed good prognosis(mRS score: 0-2)and 35(54.7%)presented poor prognosis(mRS score: 3-6);10(15.6%)patients showed hemorrhagic transformation;4(6.3%)patients died.In single factor correlation analysis,NIHSS score was higher,thrombolytic time window was longer,blood oxygen saturation was lower and body temperature was higher in the poor prognosis group than the good prognosis group.Multi-factor correlation analysis revealed that under other factors unchanged,the probability of poor prognosis in patients with NIHSS score increasing 1 was 2.974 times higher than that of patients without increase in NIHSS score(P = 0.006);the probability of poor prognosis in patients with thrombolytic time window increasing 1 hour was 11.05 times higher than that of patients without increase in thrombolytic time window(P = 0.038).It was shown that NIHSS score and thrombolytic time window were two independent risk factors affecting the prognosis of patients.In the correlation analysis of arteriovenous thrombolysis,meta-analysis was applied to the systematic evaluation due to that fact that patients with arterial thrombolysis are few(n=5).In the meta-analysis of arteriovenous thrombolysis,a total of 682 articles were obtained after retrieving PubMed,Cochrane,Google Scholar databases,EMbase and Medline databases.After screening,a total of 3 randomized controlled studies(RCT)were included,with 103 patients undergoing arterial thrombolysis and 141 receiving venous thrombolysis.Combined effect was Z = 4.24(P < 0.005),suggesting that the prognosis of patients with acute ischemic stroke undergoing arterial thrombolysis with alteplase may be superior to the venous thrombolysis.Conclusions1.NIHSS score before/after thrombolysis and thrombolysis time window are two independent risk factors affecting the prognosis of patients;2.The prognosis of patients with acute ischemic stroke undergoing arterial thrombolysis with alteplase may be superior to the venous thrombolysis.The results mentioned above still need to be confirmed by randomized controlled trials with large samples.