摘要
目的 探讨入院时脑血流动力学参数与未接受再灌注治疗急性脑梗死(ACI)患者早期神经功能恶化(END)的关系.方法 选取2022年3月—2023年6月新乡市中心医院收治的150 例ACI患者,均于发病72 h入院治疗,根据入院7 d内是否出现END分为END组(n=23)和非END组(n=127),收集两组患者入院时相关临床指标,包括一般资料、既往病史、TOAST分型、脑卒中影响的脑循环分类、入院时脑血流动力学参数、实验室指标、美国国立卫生研究院卒中量表(NIHSS)评分等临床相关资料,利用多因素Logistic回归分析END的相关因素,并利用ROC曲线验证相关因素的临床价值.结果 END组患者男性、有高血压、既往有缺血性脑卒中、既往有心脏病史、既往有抗凝药物使用史的占比均高于非END组(均P＜0.05),END组入院NIHSS评分高于非END组(P＜0.05);END组入院HDL-C水平低于非END组(P＜0.05);END组患者入院Vs、Vd、Vm均低于非END组(均P＜0.05).多因素Logistic回归分析结果显示,入院NIHSS、Vs、Vd、Vm是影响未接受再灌注治疗ACI患者发生END的独立危险因素(OR:1.442、0.969、0.352、0.933;95%CI:1.032～2.013、0.945～0.994、0.183～0.677、0.902～0.965,均P＜0.05).ROC曲线分析结果显示,入院NIHSS评分、Vs、Vd、Vm均具有预测未接受再灌注治疗ACI患者发生END的价值(P＜0.05).结论 导致未接受再灌注治疗的ACI患者发生END的原因复杂,其中入院NIHSS评分、大脑中动脉Vs、Vd、Vm是影响未接受再灌注治疗ACI患者发生END的独立危险因素,且具有预测价值.
Abstract
Objective To investigate the relationship between cerebral hemodynamic parameters at admission and early neurological deterioration(END)in patients with acute cerebral infarction(ACI)without reperfusion therapy.Methods 150 patients with ACI admitted to Xinxiang Central Hospital from March 2022 to June 2023 were selected,all of whom were admitted 72 hours after the onset of the disease.According to whether END occurred within 7 days of admission,they were divided into END group(n=23)and non-end group(n=127),and relevant clinical indicators were collected at admission of the two groups,including general data,past medical history,TOAST classification,cerebral circulation affected by stroke,cerebral hemodynamic parameters upon admission,laboratory indicators,National Institutes of Health Stroke Scale(NIHSS)score and other clinical relevant data,multivariate Logistic regression was used to analyze the relevant factors at the END.The ROC curve was used to verify the clinical value of related factors.Results The proportion of male patients with hypertension,ischemic stroke,history of heart disease and history of anticoagulant drug use in END group was higher than that in non-END group(all P＜0.05),and the admission NIHSS score in END group was higher than that in non-END group(P＜0.05).HDL-C level in the END group was lower than that in the non-END group(P＜0.05).Vs,Vd and Vm in the END group were lower than those in the non-END group(all P＜0.05).Multivariate Logistic regression analysis showed that NIHSS score,Vs,Vd and Vm were independent risk factors for END in ACI patients who did not receive reperfusion therapy(OR:1.442,0.969,0.352,0.933;95%CI:1.032-2.013,0.945-0.994,0.183-0.677,0.902-0.965,all P＜0.05).ROC curve analysis showed that NIHSS score,Vs,Vd and Vm were all valuable in predicting END of ACI patients who did not receive reperfusion therapy(P＜0.05).Conclusion The causes of END in ACI patients who did not receive reperfusion therapy are complex,among which admission NIHSS score,middle cerebral artery Vs,Vd and Vm are independent risk factors for END in ACI patients who did not receive reperfusion therapy,and have predictive value.
NETL
NSTL
万方数据