实用老年医学

实用老年医学 ›› 2023, Vol. 37 ›› Issue (4): 369-372.doi: 10.3969/j.issn.1003-9198.2023.04.012

• 临床研究 • 上一篇    下一篇

老年缺血性脑卒中病人超急性期尿激酶静脉溶栓疗效的影响因素分析

陈益升, 陈凤兰, 谢玉英, 肖兆祥, 宋峥宏, 秦洁行, 高丽   

  1. 364200 福建省龙岩市,上杭县医院神经内科(陈益升,陈凤兰,谢玉英,肖兆祥);
    200127 上海市,上海交通大学医学院附属仁济医院神经内科(宋峥宏,秦洁行,高丽)
  • 收稿日期:2022-04-13 出版日期:2023-04-20 发布日期:2023-03-31
  • 通讯作者: 高丽,Email:gaoli246619@126.com
  • 基金资助:
    上海交通大学医学院附属仁济医院国自然推进项目(RJTJ22-MS-011)

Influencing factors of intravenous thrombolysis efficacy of urokinase in the treatment of ischemic stroke at hyperacute stage in elderly patients

CHEN Yi-sheng, CHEN Feng-lan, XIE Yu-ying, XIAO Zhao-xiang, SONG Zheng-hong, QIN Jie-xing, GAO Li   

  1. Department of Neurology, Shanghang County Hospital, Longyan 364200, China(CHEN Yi-sheng, CHEN Feng-lan, XIE Yu-ying, XIAO Zhao-xiang);
    Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China(SONG Zheng-hong, QIN Jie-xing, GAO Li)
  • Received:2022-04-13 Online:2023-04-20 Published:2023-03-31
  • Contact: GAO Li, Email: gaoli246619@126.com

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摘要： 目的 探讨影响老年缺血性脑卒中病人超急性期尿激酶静脉溶栓疗效的相关因素。方法 回顾性分析我院2009~2019年接受尿激酶静脉溶栓治疗的185例老年超急性期缺血性脑卒中病人的临床资料,定义入院第7天与入院时NIHSS评分减少≥1分为溶栓改善,将病人分为未改善组(n=62)和改善组(n=123)。采用Logistic回归分析尿激酶静脉溶栓疗效的影响因素。结果 溶栓前入组病人的NIHSS中位评分为8.90分,溶栓后第7天NIHSS中位评分为6.03分,两者差异有统计学意义(P＜0.05)。2组病人合并房颤的比例差异有统计学意义(P＜0.05)。多因素Logistic回归分析显示,合并房颤和溶栓前血糖高是老年急性缺血性脑卒中病人尿激酶静脉溶栓疗效不良的独立危险因素(OR=4.71,95％CI:2.26～10.18,P＜0.01;OR=1.10,95％CI:1.01～1.20,P＝0.02)。结论 尿激酶静脉溶栓治疗超急性期老年缺血性脑卒中病人总体有效,但对于合并房颤或溶栓前血糖高的病人疗效欠佳。

关键词: 缺血性脑卒中, 静脉溶栓, 尿激酶, 老年人, 房颤

Abstract: Objective To explore the related factors affecting the efficacy of urokinase intravenous thrombolysis in the treatment of ischemic stroke at hyperacute stage in the elderly patients. Methods The clinical data of 185 elderly patients with hyperacute ischemic stroke who received intravenous thrombolytic therapy with urokinase in our hospital from 2009 to 2019 were retrospectively analyzed. The score of National Institute of Health stroke scale (NIHSS) decreased ≥1 point on the 7th day of admission than that at admission was defined as thrombolysis improvement, the patients were divided into the improvement group (n=62) and the non-improvement group (n=123). The influencing factors that affect the efficacy of intravenous thrombolysis with urokinase were evaluated by multivariate Logistic regression analysis. Results The median NIHSS score of the patients before thrombolysis was 8.90, compard with 6.03 on the 7th day after thrombolysis (P<0.05). There was a significant difference in the proportion of patients with atrial fibrillation (AF) between the improvement group and the non-improvement group (P<0.05). Multivariate Logistic regression analysis showed that AF and hyperglycemia before thrombolysis were the independent risk factors for poor efficacy of urokinase intravenous thrombolysis in the elderly patients with acute ischemic stroke (OR=4.71,95％CI: 2.26-10.18,P＜0.01;OR=1.10,95％CI: 1.01-1.20,P＝0.02). Conclusions Intravenous thrombolytic therapy with urokinase shows effects in the elderly patients with hyperacute ischemic stroke, but shows no effects in the patients with AF or hyperglycemia before thrombolysis.

Key words: ischemic stroke, intravenous thrombolysis, urokinase, aged, atrial fibrillation

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