| BackgroundAcute cerebral infarction is a very high incidence、morbidity disease, and the timeliness and rationality of the treatment have important influence on the prognosis of patients.Intravenous thrombolysis with Recombinant tissue plasminogen activator(rt-PA) is now confirmed that the only effective way of treatment to acute cerebral infarction, because of its quickly recover half dark belt blood perfusion. The patients’baseline, different causes and risk factors were the key factors affecting the prognosis, and become the hot and difficulties topics in the study of intravenous thrombolysis. There was still lack of research about TCM syndromes distribution of super early cerebral infarction and its effect on the prognosis of intravenous thrombolysis, so it is necessary to further explore.ObjectiveAnalysis the influencing factors of early neurologic outcome and long-term prognosis of super early cerebral infarction with rt-PA intravenous thrombolysis,explore the correlation between different pathogenesis and prognosis,summarize TCM syndrome distribution and evolution law of the patients with intravenous thrombolysis, in order to guide the combine traditional Chinese and western medicine treatment of cerebral infarction.MethodsRetrospective analysis the clinical data of super early cerebral infarction patients with rt-PA intravenous thrombolysis, who were admitted to Guangdong hospital of TCM in October2008to February2014.Clinical data included sex, age, smoking, drinking, medical history, onset to start thrombolysis time interval, pre-thrombolysis NIHSS score, pre-thrombolysis the vital signs, pre-thrombolysis blood sugar level, hemorrhage transformation as well as the different pathogenesis, TCM syndrome types. Evaluate the early ending of24h and long-term prognosis of90d, hemorrhage transformation and mortality. Using logistic multifactor analysis to discuss correlations of the above factors and venous thrombolysis curative effect.ResultsA total of61patients were included in this study,33were male(54.1%) and28female (45.9%),33(54.1%) patients had early good ending and26(42.6%) with good long-term prognosis;There were7(11.5%)patients appeared with hemorrhagic transformation,5with sICH and5cases died (8.2%).(1)According to the ingle factor analysis, than the bad early ending group, the early good-end group patients had a lower men ratio(42.4%vs67.9%), and systolic blood pressure (150.4±24.9mmHg vs169.2±22.8mmHg) and blood glucose levels before thrombolysis(8.2±2.9mmol/L vs11.5±3.2mmol/L) were significantly lower, significantly fewer merger intracranial vascular stenosis(24.2%vs50.2%);Patients with90d forward good prognosis were younger than the bad prognosis ones(66.4±11.Oy vs73.3±9.1y), and NIHSS score before thrombolysis (9.8±3.7vs15.0±6.8), systolic blood pressure (148.7±26.3mmHg vs166.7±22.5mmHg) and blood glucose levels (7.2±2.6mmol/L vs11.6±2.8mmol/L) were significantly lower, merge history of atrial fibrillation(7.7%vs37.1%) and intracranial vascular stenosis(15.4%vs51.4%) were less, all differences of the factors above were statistically significant (P<0.05).(2)According to multiple factors analysis, blood sugar level before thrombolysis≥8. Ommol/L is a independent risk factor of recent outcomes (OR=0.087,95%CI:0.012～0.64, P<0.05);NIHSS score≥15before thrombolysis (OR=0.028,95%CI:0.19～0.41,P<0.01), blood sugar level before thrombolysis≥8.0mmol/L(OR=0.12,95%CI:0.39～2.98,P<0.05), accompanied by intracranial vascular stenosis (OR=1.3,95%CI:0.058～18.7,P<0.05), history of atrial fibrillation(OR=6.0,95%CI:0.9～40.5,P<0.05) are independent risk factors of long-term prognosis.The study showed that, there were40cases of artery atherosclerosis in CISS parting(65.6%), the carrier blocking the perforators artery was9cases (14.8%), artery embolism was19cases (31.1%), there was impaction between type and recent neurological outcome or long-term prognosis, and no statistically significant difference, which may be associated with small sample size. There were7cases with hemorrhagic transformation after rt-PA intravenous thrombolysis(11.5%), and Atrial fibrillation might increase the risk of HT of venous thrombolysis (P<0.05). Along with the development of the illness, empirical gradually reduce, the wind fell the most obvious, and deficiency syndrome especially qi deficiency increase gradually, but the acute phase of blood stasis syndrome throughout the course. The analysis of TCM syndrome distribution to outcome found that different symptom factors has no influence on the near future or long-dated curative effect. ConelusionRt-PA intravenous thrombolysis in super early cerebral infarction is a safe and effective treatment. Pre-thrombolysis blood sugar level had a negatively correlated with venous thrombolysis effect, the long-term prognosis had correlation with thrombolysis NIHSS score, whether intracranial vascular stenosis, atrial fibrillation, the history of atrial fibrillation can increase the risk of hemorrhagic transformation after venous thrombolysis. Large artery atherosclerosis was the most type belongs to CISS classification, but each subtype has nothing with early outcome or long-term prognosis. Super early TCM syndrome in patients with cerebral infarction was given priority to with the empirical, subsequent ratio gradually decline, deficiency syndrome was increased obviously, but blood stasis syndrome through the acute phase. |
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