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目的探讨影响急性脑梗死患者临床预后的相关因素,为脑梗死的临床治疗提供依据。方法对75例发病8h内的急性脑梗死患者进行CT平扫、CT灌注成像(CTP)检查,在发病当天采用美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评价临床神经功能缺损情况,在发病90d时采用改良的Rankin量表(modified Rankin Scale,mRS)评价预后功能残疾水平。通过logistic单因素和多因素回归分析与临床预后相关的危险因素。结果 75例患者中,40例(53.3%)预后较好,经多因素logistic回归分析,结果显示,发病时NIHSS评分(OR=1.361,95%CI:1.125～1.648)和溶栓治疗(OR=0.135,95%CI:0.036～0.510)与预后评分有明显的相关性,患者的高血压、糖尿病和房颤病史以及CTP各参数与90d的临床预后无明显相关性。结论对急性脑梗死患者应进行综合评估,根据患者的具体情况,尽早选择溶栓治疗以改善预后。
Objective To investigate the related factors that influence the clinical prognosis of patients with acute cerebral infarction and provide the basis for the clinical treatment of cerebral infarction. Methods 75 patients with acute cerebral infarction within 8 hours after onset were examined with CT scan and CT perfusion imaging (CTP). On the day of onset, the clinical neurological deficit was evaluated using the National Institutes of Health Stroke Scale (NIHSS) At the 90th day of onset, the modified Rankin Scale (mRS) was used to evaluate the level of prognosis disability. Risk factors associated with clinical outcome were analyzed by logistic single factor and multivariate regression. Results Among the 75 patients, 40 patients (53.3%) had good prognosis. The multivariate logistic regression analysis showed that NIHSS score (OR = 1.361, 95% CI: 1.125-1.648) and thrombolytic therapy (OR = 0.135, 95% CI: 0.036-0.510) were significantly correlated with the prognostic score. The patients’ history of hypertension, diabetes mellitus and atrial fibrillation as well as CTP parameters had no significant correlation with the 90-day clinical prognosis. Conclusions Patients with acute cerebral infarction should be evaluated comprehensively. According to the specific conditions of patients, thrombolytic therapy should be selected as early as possible to improve the prognosis.