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[目的]探讨缺血性脑卒中急性期治疗结果与可能的影响因素的关系。[方法]回顾性收集上海市普陀区中心医院神经内科2012年1月—8月发病72 h内就诊的急性缺血性脑卒中,且NIHSS评分≥4分的109例患者资料。治疗结局按照急性期(2周)神经功能缺损评分(NIHSS)、治疗后改善情况分为显效组(>30%)、改善组(10%～30%)、无改善组(<10%)、加重组(<0分)和死亡组5组,采用卡方检验和Logistic回归分析研究可能的影响因素与治疗结果的关系。[结果]缺血性脑卒中急性期治疗结果与性别、吸烟史、OCSP分型、是否合并高血压病、糖尿病、冠心病、高脂血症、是否为复发无显著相关性(P>0.05),而与年龄、是否初始NIHSS评分>10分、是否合并发热及发病72 h内有无使用降压药物显著相关(P=0.043,0.023,0.003,0.002),其中是否使用钙离子拮抗剂CCB降压与疗效差异显著相关(P=0.001),而是否使用ACEI或ARB降压与疗效差异无显著相关性(P=0.169)。Logistic分析结果进一步证实,使用降压药物是降低缺血性卒中急性期治疗效果的主要危险因素(OR=4.406,95%CI:1.84-10.53)。[结论]缺血性脑卒中NIHSS>10分预示急性期治疗结果不佳,且发病72 h内应尽量避免使用各种降压药物,尤其是钙离子拮抗剂。
[Objective] To investigate the relationship between acute treatment of ischemic stroke and possible influencing factors. [Methods] The data of 109 patients with acute ischemic stroke treated within 72 hours of onset from January to August in 2012 in Shanghai Putuo Central Hospital and NIHSS score≥4 were retrospectively collected. The treatment outcome was divided into two groups according to the acute phase (2 weeks) neurological deficit score (NIHSS) and improvement after treatment. The treatment group was divided into the effective group (> 30%), the improvement group (10% ~ 30% In the severe group (<0 point) and death group (5 cases), the relationship between the possible influencing factors and the treatment outcome was analyzed by chi-square test and Logistic regression analysis. [Results] The results of acute phase of ischemic stroke showed no significant correlation with gender, smoking history, OCSP classification, whether complicated with hypertension, diabetes, coronary heart disease, hyperlipidemia, and recurrence (P> 0.05) (P = 0.043,0.023,0.003,0.002), whether the use of calcium-ion antagonist CCB or not, whether or not the initial NIHSS score> 10 points, with or without fever combined with fever within 72 hours of onset There was a significant correlation between pressure and efficacy (P = 0.001), but there was no significant correlation between the use of ACEI or ARB and efficacy difference (P = 0.169). Logistic analysis further confirmed that the use of antihypertensive drugs is a major risk factor for the reduction of acute ischemic stroke (OR = 4.406, 95% CI: 1.84-10.53). [Conclusions] NIHSS> 10 points in ischemic stroke indicate that acute treatment results are poor, and various antihypertensive drugs, especially calcium antagonists, should be avoided within 72 hours.