The Application Value Of ABCD3-? Score In Thrombolytic Therapy Of Mild Stroke

Objective:To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in mild stroke patients;To investigate the application value of ABCD3-? score in thrombolytic therapy of mild stroke.Methods:A total of 183 patients with mild stroke admitted to the department of neurology,handan first hospital from September 2016 to May 2018 were included in this study,and all patients received treatment within 4.5 hours after onset.Among them,28 cases fell off and 155 cases had complete data.Mild Stroke was defined as a national Institutes of Health Stroke Scale(NIHSS)score of less than or equal to 5 at admission,with 0 or 1 for each item and 0 for consciousness.Among them,80 patients received rt-PA thrombolytic therapy,and 75 patients did not receive rt-PA thrombolytic therapy,to evaluate the early efficacy,long-term prognosis and safety of the thrombolytic group and the control group.According to ABCD3-? score,155 patients with mild stroke were divided into low-risk group(35 cases),medium-risk group(60 cases)and high-risk group(60 cases),and the early efficacy,long-term prognosis and safety of the three groups of patients in the control group were evaluated respectively.Early curative effect:the NIHSS score before and 7 days after treatment was compared,and the NIHSS score decreased by 18% or more after treatment was defined as effective in early treatment.An increase of 18% or more was defined as early deterioration of neurological function.Long-term prognosis: 90 patients with Modified Rankin Scale(mRS)were rated as having a good prognosis by 0-1.The 90 dmRS score 2-6 was classified as poor prognosis.Safety: the incidence of symptomatic intracranial hemorrhage(sICH)within7 days after treatment with rt-PA was analyzed.The mean and standard deviation was used to represent the measurement data,and t test was used for the comparison between groups;chi-square test was used to compare counting data.P < 0.05 was considered statistically significant.Results: Efficacy and safety of thrombolytic therapy for mild stroke:Among the155 patients with mild stroke,the early treatment response rate was 66.3% in the thrombolytic group,the early deterioration rate of neurological function was 10%,the90 d prognosis failure rate was 12.5%,the bleeding conversion rate was 1.3%,and therewas no sICH or death.The effective rate of early treatment in the control group was40%,the rate of early deterioration of neurological function was 20%,the rate of poor prognosis at 90 days was 26.7%,the rate of bleeding conversion was 0%,and there was no sICH or death.The difference between the effect of early treatment and poor prognosis at 90 days was statistically significant(66.3%vs.40%,P=0.001;12.5%vs.26.7%,P=0.026),the remaining difference was not statistically significant.ABCD3-? score predicted the prognosis of mild stroke:75 patients with mild stroke who did not receive thrombolytic therapy were divided into low,medium and high risk patients according to ABCD3-? score,and the early efficacy and long-term prognosis of the three groups were evaluated.The higher the risk grade was,the greater the risk of early progression was,and the difference was statistically significant(5.6%vs.14.8%vs.33.3%,P=0.047).There was no statistically significant difference between the effect of early treatment and the prognosis after 90 days.ABCD3-? score was used to predict the efficacy of thrombolytic therapy for mild stroke:115 patients with mild stroke were divided into low,medium and high-risk patients according to ABCD3-? score,and the early efficacy and long-term prognosis of the thrombolytic group and the control group of the low,medium and high risk patients were evaluated respectively.There was no significant difference in early efficacy and long-term prognosis between the thrombolytic group and the control group in low and medium risk patients.There was a statistically significant difference between the efficacy of early treatment and early deterioration of neurological function between the two groups of high-risk patients(66.7%vs.25.9%,P <0.001;10%vs.33.3%,P=0.033),no statistical significance was found in the 90 d prognosis.Conclusion:Intravenous thrombolysis can improve the early treatment efficiency of patients with mild stroke,improve the prognosis after 90 days,and do not increase the risk of bleeding;ABCD3-? score can better predict the efficacy of early thrombolytic therapy for mild stroke.