Analysis Of Influencing Factors Of Poor Prognosis In Acute Cerebral Infarction Treated With Alteplase Thrombolytic Therapy

Objective: To investigate the factors affecting the early(14 days post-thrombolytic therapy)and long-term(3 months post-thrombolytic therapy)poor prognosis in patients with acute cerebral infarction.In order to improve the prognosis of patients with acute cerebral infarction thrombolysis,to prevent the deterioration of disease,improve the safety and effectiveness of thrombolytic therapy,improve the quality of life of patients.Methods: A total of 167 patients with acute cerebral infarction who received intravenous thrombolytic therapy with alteplase from November 2020 to September 2022 in Inner Mongolia Forestry General Hospital were included consecutively.Among them,7 died within 14 days after thrombolytic therapy.All data could not be collected and 2 were lost to follow-up.The general,clinical and follow-up information of 158 patients were completely recorded.The short-term and long-term curative effects were based on the Modified Rankin Scale(MRS)scores 10-14 days after thrombolysis and three months after discharge.They were divided into good prognosis group(MRS ≤2)and poor prognosis group(MRS > 2),and the two groups were recorded,prospectively summarized and compared.Results: After 14 days of thrombolytic therapy,101 patients had good prognosis and 57 patients had poor prognosis.After 3 months of thrombolysis,there were 115 cases in the good prognosis group and 43 cases in the poor prognosis group.Univariate analysis showed that age,home care,history of diabetes,history of atrial fibrillation,early improvement of neurological function(NIHSS score change)and aphasia grade after 14 days of thrombolytic therapy were the influencing factors of early curative effect.Age,home care,history of diabetes,history of atrial fibrillation,14-day aphasia grade at thrombolysis,post-stroke depression PSD,comorbidities,and compliance with rehabilitation exercises were factors influencing the long-term prognosis.Multivariate logistic regression analysis indicated that age(OR=1.05,95%CI: 1.00-1.10,P=0.046),atrial fibrillation(OR=5.03,95%CI: 1.21-20.87,P=0.026),neurological deterioration24 h after thrombolysis(OR=9.33,95%CI: 1.73-50.39,P=0.009)was an independent risk factor for short-term poor prognosis,and aphasia grade was grade 5 after 14 days of thrombolysis(OR=0.02,95%CI: 0.01 0.09,P(27)0.001)were protective factors for short-term prognosis;Age(OR=1.40,95%CI: 1.17-1.68,P(27)0.001),concomitant disease(OR=11.22,95%CI: 1.42-88.69,P=0.022),poststroke depression(OR=12.22,95%CI: 2.55-28.58,P=0.002)were independent risk factors for long-term poor prognosis,child care(OR=0.05,95%CI: 0.01-0.49,P=0.010),high compliance with rehabilitation(OR=0.01,95%CI: 0.01-0.09,P(27)0.001)were protective factors for long-term prognosis.Conclusions1.Advanced age,history of atrial fibrillation,and early neurological deterioration after thrombolysis may adversely affect the short-term prognosis of patients;Patients with grade 5aphasia had better short-term outcomes than those with grade 0-2 aphasia.2.Older age,concomitant disease,after thrombolysis in poststroke depression can cause bad influence on the long-term prognosis of patients with;Child care is beneficial for long-term outcomes compared to living alone;Patients with high adherence to rehabilitation exercise have better long-term outcomes.