| Objective:We aim to explore the clinical effect of thrombolytic therapy on acute anterior circulation infarction patients based on retrospective analysis on clinical data.Investigating whether the location of infarction would influence the successful recanalization rates of patients who received thrombolytic therapy.To compare the effect of different infarction type,infarction site and hemorrhage transformation on prognosis of patients.Based on this study,we aim to provide effective clinical evidence for acute anterior circulation infarction precaution and cure.Methods:We enrolled 312 patients with acute anterior infarction who were treated in our hospital from January 2015 to December 2017 as group.199 patients have received thrombolytic therapy and 113 patients haven't received the thrombolytic therapy.As for thrombolytic therapy group,the age of the patients were 45 to 83,and the average age was68.1±4.21.There were 87 male patients and the average age was 66.4±5.09,112 female patients and the average age was 68.8±4.26.In no thrombolytic therapy group,there were59 male,the age of the no thrombolytic therapy were 48 to 84,and the average age was67.56±4.78,There were 54 female,the age of the healthy group were 38 to 84,,and the average age was 69.23±5.23.1.The general clinical data,including age,gender,smoking history,drinking history,diabetes,hypertension,heart disease,hyperlipidemia,stroke history,have been analyzed for the frequency,and we further use of X~2 test to evaluate the difference of the patients in thrombolytic group and non-thrombolysis group distribution consistent.2.According to the 1993 American TOAST classification method,the etiology of acute cerebral infarction was classified,and the most common etiological types of acute cerebral infarction were determined.3.The patient's infarct location was analyzed based on the CT and MRI results of the patient's head.4.In thrombolytic and non-thrombolytic groups,312 patients were divided into 5groups according to the results of TOAST typing.NIHSS scores were performed in 24 h and 7 days after treatment,and the clinical efficacy of conventional treatment was analyzed.In the treatment of 14 d,the probability of hemorrhagic transformation was measured.The mRS score was performed on the 90 days after discharge,and the prognosis of the 5 groups was analyzed.All data was processed with statistics software SPSS 17.0,there exist significant difference when P<0.05.Result:1.As for acute anterior circulation infraction patients,hypertension patients were 233,accounting for 74.68%of all patients,following diabetes(86;27.56%),the history of stroke(85;27.25%)and hyperlipidemia(84;26.92%).Logistic indicates that hypertension(OR:3.62±0.47,P<0.05),diabetes mellitus(OR:4.21±1.25,P<0.05),hyper LDL(OR:5.28±2.13,P<0.05)?cardiac disease(OR:4.12±1.53,P<0.05)were risk factor for Acute anterior circulation cerebral infarction.2.The most common subtype of acute anterior circulation infraction is Atherosclerosis of large vessels.Logistic indicates that Atherosclerosis of large vessels(OR:0.62±0.13,P<0.05)and small artery occlusion(OR:0.33±0.06,P<0.05)experience better prognosis in thrombolysis group;in non-thrombolysis group,cardioembolism(OR:5.19±1.32,P<0.05)is a risk factor for prognosis.3.The number of middle cerebral artery occlusion patients is 180,accounting for57.8%of total patients.The number of Internal carotid artery infarction patients is 113,accounting for 36.2%of total patients.The number of Anterior cerebral artery infarction patients is 19,accounting for 6%of total patients.4.Among the 312 patients,the incidence of total hemorrhagic conversion is 5.12%.The highest percentage of patients receiving thrombolytic therapy is 13(6.53%in thrombolytic group).The probability of hemorrhagic cerebral infarction in patients with pre-circulatory cardiogenic cerebral infarction is significantly higher than that of other types of patients with anterior circulation cerebral infarction.Venous thrombolysis increases the risk of bleeding in the cardiogenic embolism,but the hemorrhage conversion group does not increase the poor prognosis.The NHISS score of 7D in the thrombolytic thrombolytic group was significantly improved.5.Among the patients with acute anterior circulation cerebral infarction,thrombolytic is the factor that affects the clinical benefit and prognosis of the patients.The prognosis of patients receiving thrombolytic therapy(68.8%patients)is significantly better than those receiving thrombolytic therapy(54.8%patients)(P<0.05);and thrombolytic therapy at discharge in patients with NIHSS score(6.01±2.45),is lower than patients who received thrombolytic therapy(7.52±3.03)(P<0.05);in addition,occurrence of anterior cerebral artery the prognosis of patients with infarction(85.7%patients with good prognosis)is better than that of middle cerebral artery infarction(72.4%patients)(P<0.05).6.As for patients who received thrombolytic therapy,the time of thrombolytic therapy and the location of infarction would influence the effect of thrombolytic treatment.Patients who received thrombolysis within 4.5 hours from stroke had better prognosis than others.And patients with anterior cerebral artery infarction benefitted more from thrombolytic therapy than patients with internal carotid infarction.Logistic indicates that Anterior cerebral artery occlusion(OR:4.19±2.37,P<0.05)and middle cerebral artery(OR:3.22±0.89,P<0.05)were risk factors for prognosis;and middle cerebral artery(OR:0.31±0.22,P<0.05)experiences better prognosis.Conclusion:The acute anterior circulation infarction patients were usually accompanied with hypertension,diabetes and high LDL;the most common clinical symptom was acroparalysis;The percentage of middle cerebral artery stroke was most common;thrombolytic therapy can perform significant clinical effect on acute anterior circulation infarction patients.Patients who received thrombolytic therapy were prone to suffer from hemorrhagic transformation,and the hemorrhagic location were prone to be anterior cerebral artery.Although patients with cardioembolism were inclined to happen hemorrhagic transformation,their prognosis were still good.And patients with internal carotid infarction have better prognosis than patients with middle cerebral artery infarction.As for patients who received thrombolytic therapy,Early thrombolysis is the prerequisite of successful recanalization and better prognosis.The lower the NHISS score,the better the thrombolytic effect.Therefore,the thrombolysis should not be stopped for the cardiac infarction,which should not be considered to increase the risk of bleeding. |
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