The Definition,risk Factors And Prognosis Of Early Neurological Deterioration After Intravenous Thrombolysis With Ischemic Stroke

Objective: The early neurological deterioration(early neurological deterioration,END)of acute ischemic stroke(Acute ischemic stroke,AIS)refers to the deterioration of the patient's neurological function after intravenous thrombolytic treatment in the short term,or progressively or step by step deterioration.END is highly suggestive of poor long-term prognosis.There is no effective way to predict END.The purpose of this paper is to explore the clinical value of different definitions of early neurological deterioration;the risk factors for early neurological deterioration after intravenous thrombolytic therapy in acute ischemic stroke,and the relationship between early neurological deterioration and prognosis of patients.To explore the clinical application value of different definitions of early neurological deterioration.Methods: 333 patients with acute cerebral infarction treated with intravenous thrombolytic therapy in our hospital were divided into two groups with baseline NIHSS score of 6.The difference of different clinical factors between END and not END patients in each group was compared.Including general data(gender,age,age,blood pressure,history of past medical history,history of drug use,baseline NIHSS score),laboratory examination(white cell count,platelet count,international standardized ratio,fibrinogen,activated partial thromboplastin time,uric acid,total cholesterol,low density lipoprotein,triglyceride,high density Lipoprotein,glycosylated hemoglobin,fasting blood glucose,homocysteine,hypersensitivity C reaction protein),imaging examination(cerebral vascular ultrasound,carotid ultrasound,head MRI),prognosis(thrombolytic 1 months,3 months,6 months m RS score).Spss22.0 software was used for statistical analysis.Results: The part one: Definition and incidence of early neurological deterioration A total of 333 people were included,34 with END,10.2% for END,78 in the baseline NIHSS score,19.2% for END,255 for baseline NIHSS score,and 7.5% for END.The part two: Risk Factors for Early Neurological Deterioration For all the patients,the baseline NIHSS score,emergency systolic pressure,emergency diastolic pressure,white blood cell count,emergency fingertip blood sugar,fasting blood glucose,and the degree of vascular stenosis were statistically significant with END.The results of multifactor analysis showed that the degree of stenosis of responsible vessels(OR=3.949,9)5% CI= 2.196~7.103),homocysteine(every increase of 1umol/l: OR=1.03,95% CI= 1.009~1.051),emergency blood glucose level(every increase of 1mmol/l: OR=1.217,95% CI= 1.037~1.427),and baseline NIHSS score(every 1 points: OR=0.813,95% CI= 0.733~0.901)associated with thrombolytic thrombolysis(0.05)as thrombolytic Independent risk factors of END in patients.For the thrombolytic patients with a baseline NIHSS score less than 6,the single factor analysis showed that the leukocyte count,the level of homocysteine,the emergency fingertip blood glucose and the degree of the stenosis of the responsible vessel were associated with END,and were statistically significant.The results of multifactor analysis showed that the stenosis of the responsible vessel(OR=2.887,95% CI=1.372 ~6.074),Leucocyte count(1 x 109/L: OR=1.273,95% CI=1.003~1.616),homocysteine(each increase 1umol/l: OR=1.049,95% CI=1.006~1.092)were associated with END(P < 0.05)after intravenous thrombolysis(P < 0.05)as an independent risk factor for END at the baseline NIHSS score in the patients less than 6.For the thrombolytic patients with a baseline NIHSS score more than 6,the single factor analysis of leukocyte count,emergency fingertip blood glucose,vascular stenosis,fasting blood glucose were associated with END,and were statistically significant.The results of multifactor analysis showed that the degree of vascular stenosis(OR=3.267,95% CI=1.495 ~7.147)and emergency blood glucose level(every increase of 1mmol/l: OR=1.049,95% CI=1.049~1.6.9)was associated with END after intravenous thrombolysis(P < 0.05),which was an independent risk factor for END in patients with baseline NIHSS score more than 6.The part three: Early neurological deterioration and prognosis 3 months m RS>2 was defined as poor prognosis.Patients with END were more likely to have bad prognosis in 3 months than those who did not have END: the death rate of the END group was 60.6%,and the death rate of not END group was 35.7%.Conclusion: Emergency fingertip blood glucose,major vascular stenosis,homocysteine level,and baseline NIHSS score are independent risk factors for END.Among patients with a baseline NIHSS score less than 6,white blood cell counts,major vascular stenosis,and homocysteine levels are independent risk factors for END;patients with baseline NIHSS score more than 6,emergency fingertip glucose and major vascular stenosis are independent risk factors for END.The occurrence of END is associated with poor prognosis and death.