| Objective: To collect and analyze the clinical data of 165 patients with acute cerebral infarction treated with recombinant human tissue-type plasminogen activator rt-PA during hospitalization.To study the effects of different blood glucose levels on the safety of intravenous thrombolytic therapy in patients with acute cerebral infarction at admission and the related effects of different blood glucose levels on the clinical outcome of intravenous thrombolytic therapy in patients with acute cerebral infarction.So as to provide the relevant basis for clinical treatment.Methods:This study included 165 acute ischemic patients who underwent intravenous thrombolysis with alteplase(rt-PA)during the period from May 2014 to June 2016 in the Department of Neurology,Central Hospital of Cangzhou Central Hospital.The study collected gender,age,and risk factors for blood vessels(diabetes,hypertension,etc.).And the NIH scale before thrombolysis,the relevant drugs used before thrombolysis,blood glucose before thrombolysis,blood pressure before and after thrombolysis,and other general clinical data.This study was based on the random blood glucose levels before thrombolytic therapy in patients with thrombolytic therapy.All patients were divided into normal blood glucose group(blood glucose < 7.8 mmol/L),high glucose group(7.8 mmol/L ? blood glucose <11.1 mmol/L)and hyperglycemia group(blood glucose ?11.1 mmol/L).The NIHSS score was used to evaluate the degree of improvement of nerve function defect after intravenous thrombolytic therapy.The score ranged from 0 to 42,and the higher the score was,the more serious the nerve function defect was.It is proved that the more serious the degree of neurological impairment is,the more serious the neurological impairment is: normal or close to normal score 1~ 4: mild stroke or stroke;5~ 15:moderate stroke;15 ~ 20:moderate to severe stroke;21~42: severe stroke.Use Rankin scale to evaluate the three groups.The functional status of the three groups after intravenous thrombolytic therapy was evaluated with Barthel index score.The Barthel Index scores ranged from 0 to 100.Bathing,decorating,dressing,controlling defecation,toilet,bed chair shifting,walking flat.The Rankin scale(mRS)was used to evaluate the neurological recovery of three groups of patients receiving rt-PA intravenous thrombolytic therapy for 3 months.Among them,the mRS score of 0~1 is good prognosis of thrombolytic therapy and 2~6 is poor prognosis of thrombolytic therapy.The prognosis was divided into good prognosis group(105 cases)and poor prognosis group(60 cases).Logistic regression analysis was used to analyze the prognostic factors of intravenous thrombolytic therapy.The effects of different blood glucose levels on the prognosis of patients with intravenous thrombolytic therapy were compared.Results:1.Comparison of the improvement of NIHSS score 24 hours after intravenous thrombolytic therapy in three groups with different blood glucose levelsComparison of the improvement of NIHSS score 24 hours after intravenous thrombolytic therapy,there were 83 cases of normal blood glucose group,47 cases of hyperglycemia group and 35 cases of hyperglycemia group(P<0.05).The scores of NIHSS were improved 2 weeks after thrombolytic thrombolytic therapy(P<0.05),and were [8.05 ±4.79 vs 9.765 ±5.22 vs 12.45 ±4.78] P<0.05 respectively.The normal blood glucose group(n = 83)and hyperglycemia group(n = 47)and hyperglycemia group(n = 35)were[6.75±4.72 vs 7.54±6.12 vs 10.06±6.25](P<0.05).After treatment,the NIHSS scores of the three groups were significantly lower than those of before treatment,and the NIHSS scores decreased gradually with the prolongation of time(P<0.05).The NIHSS scores of 24 h and 2 weeks after thrombolytic therapy in three groups with different blood glucose levels were significantly different(P<0.05).The scores of normal blood glucose group,hyperglycemic group and hyperglycemic group decreased(4.10 vs 2.82 vs 0.81)at 24 h after treatment,and decreased(5.40vs5.04vs3.2)at 2 weeks after treatment.the scores of normal blood glucose group decreased more rapidly(P<0.05).2.Comparison of the improvement of Barthel index after intravenous thrombolytic therapy in three groups with different blood glucose levelsThe Barthel index scores after thrombolysis were[74.12 ± 27.86 vs72.16 ± 28.25 vs 70.06 ± 26.67].The Barthel index scores after thrombolysis were improved after thrombolytic therapy in 83 cases of normal blood glucose group,47 cases of hyperglycemia group and 35 cases of hyperglycemia group.But the normal blood glucose level group was better than the other two groups.there was statistical significance(P<0.05).3.Comparison of prognosis and safety between patients with different blood glucose levels before and after thrombolytic therapyIn the included 165 patients,83 cases of normal blood glucose group,47 cases of the high glucose group,and 35 cases of hyperglycemia group,hemorrhage rate[3(3.61%)and 4(8.51%)and 3(8.57%)];symptomatic intracranial hemorrhage rate[1(1.20%)and 2(4.26%)and 2(5.71%)];mortality rate[1(1.20%)and 1(2.13%)and 1(2.86%)];the incidence of poor prognosis[ 8(9.63)and 19(40.42%)and 16(45.71%)](P < 0.05).The above data of hyperglycemic group and hyperglycemic group were significantly higher than those of normal glycemic group,they have statistical significance.The results showed that hyperglycemia before thrombolysis was a predictive factor for poor prognosis of thrombolysis.4.Prognostic factors of thrombolytic patientsUnivariate analysis showed that,According to mRS scores,105 patients had good prognosis and 60 patients had poor prognosis.Among them,the age of patients with good prognosis and patients with poor prognosis(64.38±10.71 vs68.58±11.23,P=0.021),number of people with diabetes(20.95%vs 41.67%,P=0.001),time from onset to thrombolytic therapy(2.28±1.13vs2.93± 1.08,P=0.015),NIHSS score before thrombolysis(10.11± 5.63 vs 14.26± 5.79,P=0.000),glycosylated hemoglobin(5.58±3.26vs7.11±2.12,P=0.003),blood glucose before thrombolysis(5.61±1.31 vs6.83±2.24,P=0.001),The above data were lower in patients with good prognosis than in patients with poor prognosis.Univariate analysis of the risk factors of P<0.05 in multivariate logistic regression analysis found that:The main risk factors influencing the prognosis of intravenous thrombolytic therapy were as follows: multivariate Logistic regression analysis showed that random blood glucose level before thrombolytic therapy,NIHSS score before thrombolytic thrombolysis,and history of diabetes mellitus,the level of glycosylated hemoglobin were the main risk factors for the prognosis of patients with acute cerebral infarction treated by intravenous thrombolysis.[OR(95%CI):1.433(1.120~2.833),1.412(1.41~1.811),7.131(1.256~39.453),1.283(1.059~1.553),P<0.05].Conclusion:1.Prethrombolytic glucose is an independent risk factor for the prognosis of patients with acute ischemic stroke treated with rt-PA intravenous thrombolysis.Poor control of blood sugar before thrombolytic can increase the probability of adverse reactions,which is not conducive to the prognosis.2.For patients with acute ischemic stroke who received rt-PA intravenous thrombolytic therapy,the prognosis was poor if the blood glucose before thrombolysis was higher than 7.8 mmol/L.3.Although hyperglycemia can affect the prognosis of thrombolytic therapy,hrombolytic therapy can still improve the neurological deficit in patients with hyperglycemia. |
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