| Background and Objectives:At present,the disease that ranks first among the causes of death of our residents is stroke[1].Among all types of stroke,60%to 80%are ischemic strokes[4].after a large number of studies have proved that for acute ischemic stroke(AIS),the treatment of ultra-early revascularization is the first choice For intravenous thrombolysis,because of the time window limitation,the patients who can reach the hospital within the effective time and can receive intravenous thrombolysis are very limited.At present,the venous thrombolysis rate of AIS patients in China is low,and there are many factors leading to this situation.The poor prognosis of AIS venous thrombolysis also limits the progress of venous thrombolysis.There are many studies on the factors affecting the prognosis of venous thrombolysis,but there is no definite theory.This study mainly consists of two parts:1.Collect the relevant data of venous thrombolysis of acute cerebral infarction in 15 medical representatives in Yanan area,and analyze the current situation of venous thrombolysis in Yanan area.2.Collect the representative patients in Yan'an University Affiliated Hospital of Yan'an District who used rt-PA intravenous thrombolysis for AIS in Yanan area,and explore the factors that affect the poor prognosis of rt-PA intravenous thrombolysis in AIS patients.Methods:1.We retrospectively collected data on venous thrombolysis in patients with acute ischemic stroke from May 2016 to May 2019 in 15 representative secondary and higher general hospitals in Yan'an.A cross-sectional questionnaire survey was used to investigate the chief person in charge of the neurology department of the hospital(by phone or face-to-face),and explain the purpose of the investigation to the person in charge and sign an informed consent;the survey mainly includes the development of intravenous thrombolysis in 15 hospitals,The amount of thrombolysis,whether to establish the thrombolysis process,medical resource allocation,and DNT time,etc.2.The clinical data of AIS patients who received rt-PA intravenous thrombolytic therapy from October 2017 to December 2019 in Yanan University Affiliated Hospital were collected retrospectively(all NIHSS scores,mRS scores,and Essen scores were jointly evaluated by neurology residents and superior physicians).Calculated from the beginning of thrombolysis,followed up by outpatient or telephone after 3 months,using the modified Rankin score scale(m RS)as a follow-up indicator,and divided into good prognosis groups according to the score m RS?2,m RS>2 Divided into poor prognosis group,using spss22.0 software right The clinical data between the different prognostic groups were statistically analyzed to analyze the factors affecting the short-term prognosis of AIS intravenous thrombolysis.Results:1.The total number of thrombolysis cases in the Yanan area has shown an upward trend in the past three years.Among the 15 hospitals surveyed,11 hospitals(73.3%)have carried out intravenous thrombolysis,and all 15 hospitals have completed cranial CT and thrombolysis Medical equipment required for all hematological indicators.Among them,only 33.3%of the hospitals introduced rt-PA for intravenous thrombolysis;of the 15 hospitals,there were 1 senior stroke center and 4 primary stroke centers.The number of thrombolysis less than 10 cases accounted for 40%.DNT time 63.6%of them met the standard;53.3%of the hospitals had independent neurology departments;20%of the hospitals had stroke thrombolysis teams;the second-tier hospitals had the largest number of thrombolysis cases;the third-tier hospital Zhongyan University The thrombolysis cases in the affiliated hospitals account for 90%of the total thrombolysis cases.2.The study finally included clinical data of 109 patients receiving rt-PA intravenous thrombolysis due to AIS.According to the mRS score,there were 63 cases in the good prognosis group and 46 cases in the poor prognosis group.After a single factor analysis,it was found that hyperglycemia,the time from onset to thrombolysis,baseline NHISS score,24h NHISS score after thrombolysis,Fazakes grade,baseline Essen score,baseline PDW level,baseline D-dimer were associated with poor prognosis of intravenous thrombolysis,A binary logistic stepwise regression analysis of the above factors,the results suggest that serum uric acid level,baseline NHISS score,hyperglycemia,24h NHISS score after thrombolysis are independent risk factors affecting the short-term prognosis of AIS receiving rt-PA intravenous thrombolysis.Conclusions:1.Although venous thrombolysis has shown an upward trend in the past three years,the overall venous thrombolysis work is not satisfactory.In conjunction with the relevant requirements of the construction of the National Stroke Center,stroke prevention and treatment in Yanan area needs to be further strengthened.2.Low uric acid levels,high blood sugar,high NHISS score before thrombolysis,and high 24h NHISS score after thrombolysis are independent risk factors for poor prognosis at 3 months after rt-PA intravenous thrombolysis in patients with acute cerebral infarction. |
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