急性脑卒中患者溶栓治疗后发生早期神经功能恶化的危险因素研究

doi:10.3969/j.issn.1002-1949.2018.03.011

Chinese Journal of Critical Care Medicine

2018, Vol. 38

Issue (3): 224-228 DOI: 10.3969/j.issn.1002-1949.2018.03.011

The risk factors of early neurological deterioration occurred after thrombolytic treatment in patients with acute stroke

Dong Lin-lin, Jiang Li-jie, Liu Ying, Liu Tie-hong

Cadre Ward, Zhongshan Affiliated Hospital of Dalian University, Dalian 116001, China

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Abstract Objective To evaluate the risk factors of early neurological deterioration (END) in patients with acute stroke after thrombolytic therapy for 24 h. Methods The clinical data of 678 patients with acute ischemic stroke who were hospitalized in ICU and received thrombolytic therapy were retrospectively analyzed. According to the occurrence of END patients after thrombolytic therapy 24 h, the patients were divided into END group and non-END group. The clinical data and prognosis of END group and non-END group were compared. The pathogenesis of END in patients was evaluated. Multivariate Logistic regression analysis was used to assess the factors associated with the occurrence of END in patients. Results Of the 678 patients, 142(20.9%) patients developed END at 24 h after thrombolysis. Univariate analysis showed that factors influencing the occurrence of END in the patients included: hypertension (χ2=5.483, P=0.019), diabetes mellitus (χ2=5.353, P=0.021), smoking (χ2=11.302, P<0.001), large-artery atherosclerosis (χ2=21.168, P<0.001), cardiogenic stroke(χ2=28.129, P<0.001) and admission NIHSS (Z=5.623, P=0.025). Large-artery atherosclerosis(OR=5.549, 95% CI=1.124～2.388, P=0.037), diabetes mellitus (OR=2.678, 95% CI=1.258～5.539, P=0.015), hypertension (OR=1.642, 95% CI=1.178～2.263, P=0.005) were significantly associated with END in patients with acute stroke treated with thrombolytic therapy for 24 h. The pathogenesis of END included ischemic progression (42/142, 29.6%), recurrence of stroke (35/142, 24.6%), hemorrhagic transformation after infarction (33/142, 23.2%) and cerebral edema (32/142, 22.6%). Conclusion Ischemic progression and recurrence of stroke are the most important reasons after thrombolytic therapy in patients with END. Diabetes, hypertension, atherosclerosis, brain edema and hemorrhagic transformation are independent predictors of the occurrence of END after thrombolytic therapy within 24 h.

Received: 12 November 2017

About author:: Dong Lin-lin, E-mail:dlldltg@sina.com

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Cite this article:

Dong Lin-lin,Jiang Li-jie,Liu Ying, et al. The risk factors of early neurological deterioration occurred after thrombolytic treatment in patients with acute stroke [J]. Chinese Journal of Critical Care Medicine, 2018, 38(3): 224-228.

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http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2018.03.011 OR http://www.cnemergency.org.cn/EN/Y2018/V38/I3/224

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