90岁及以上急性脑梗死病人接受静脉溶栓治疗的临床结局观察

doi:10.3969/j.issn.1003-9198.2025.06.010

摘要/Abstract

摘要： 目的观察90岁及以上急性脑梗死病人接受静脉溶栓治疗的临床结局,评估静脉溶栓治疗对这一人群的疗效及安全性。方法回顾性收集2018年12月至2023年12月上海市嘉定区中心医院收治的年龄≥90岁的急性脑梗死病人资料,纳入发病4.5 h内到院就诊、发病时NIHSS评分>3分、发病前改良Rankin量表(mRS)评分≤3分的病人。收集所有病人的临床结局指标,包括发病后90 d的预后情况、住院期间死亡率,以及出血转化、症状性颅内出血、肺部感染的发生情况。对接受静脉溶栓和未溶栓的病人进行分组比较。结果共入组52例病人,其中女37例,男15例,中位年龄为91岁,发病时中位NIHSS评分为13(8,20)分。有27例病人接受了静脉溶栓治疗,25例病人未接受静脉溶栓治疗。溶栓组与未溶栓组在卒中危险因素、既往史、发病时的NIHSS评分、发病前的mRS评分、TOAST分型等方面差异均无统计学意义。溶栓组与未溶栓组的功能预后良好率差异有统计学意义(33.3%比8.0%,P<0.05),2组出血转化、症状性颅内出血、肺部感染的发生率以及院内死亡率差异均无统计学意义。结论 90岁及以上急性脑梗死病人接受静脉溶栓治疗可以增加功能预后良好的比例,且没有增加症状性颅内出血的风险,临床上不应仅根据年龄而拒绝对这一人群进行静脉溶栓治疗。

关键词: 90岁以上, 急性脑梗死, 静脉溶栓, 预后

Abstract: Objective To observe the clinical outcome of intravenous thrombolysis for acute ischemic stroke in the patients aged 90 years old and over, and to evaluate the efficacy and safety of intravenous thrombolysis in this population. Methods The clinical data of the patients with acute ischemic stroke aged ≥90 years admitted to Shanghai Jiading District Central Hospital from December 2018 to December 2023 were retrospectively collected. The patients who visited the hospital within 4.5 hours of symptom onset, with a National Institutes of Health Stroke Scale (NIHSS) score >3 on admission, and a pre-stroke modified Rankin Scale (mRS) score ≤3 were enrolled. The clinical outcome of the patients were recorded, including outcome 90 d after onset, in-hospital mortality, the incidence of hemorrhagic transformation, symptomatic intracranial hemorrhage and pulmonary infection. The clinical data were compared between thrombolysis group and non-thrombolysis group. Results A total of 52 patients with a median age of 91 years were enrolled. Among them, there were 37 females (71.2%) and 15 males (28.8%), and the median NIHSS score at onset was 13 (8,20). In this study, 27 patients received intravenous thrombolysis. There were no significant differences in risk factors for stroke, previous history, NIHSS score at onset, pre-stroke mRS score, and TOAST classification between thrombolysis group and non-thrombolysis group. There was significant difference in the proportion of good outcomes between the two groups (33.3% vs 8.0%, P<0.05). There were no significant differences in the incidence rates of hemorrhagic transformation, symptomatic intracranial hemorrhage, pulmonary infection and in-hospital mortality between the two groups. Conclusions Intravenous thrombolysis can increase the proportion of good outcomes in the patients with acute ischemic stroke aged 90 years old and over, and it is safe without increasing the risk of symptomatic intracranial hemorrhage. Therefore, intravenous thrombolysis should not be denied to this population based on age alone.

Key words: nonagenarians, acute ischemic stroke, intravenous thrombolysis, outcome

中图分类号:

R743.3

张薇薇. 90岁及以上急性脑梗死病人接受静脉溶栓治疗的临床结局观察[J]. 实用老年医学, 2025, 39(6): 582-585.

ZHANG Weiwei. Clinical outcome of intravenous thrombolysis for acute ischemic stroke in patients aged 90 years old and over[J]. Practical Geriatrics, 2025, 39(6): 582-585.

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