| Objective: Compare the safety and effectiveness of intravenous thrombolysis(IVT)in patients with acute anterior circulation ischemic stroke of different pathogenesis.We explored whether patients with cardiogenic stroke that meet IVT standards should actively intravenous thrombolysis and related risk factors that affect prognosis.Method: Patients with acute ischemic stroke who were treated in the emergency department of Linyi City People's Hospital from January 2017 to June 2018 were selected,and cases that met the criteria were included in the study.The selected cases were all received alteplase(Boehringer Ingelheim,Germany)patients with acute anterior circulation ischemic stroke treated with intravenous thrombolysis.According to the TOAST etiology classification,the selected cases were divided into cardioembolism(CE)group and large-artery atherosclerosis(LAA)group.Comparison of baseline data and clinical outcomes between the two groups.Effectiveness and safety indexes were used to evaluate the clinical outcomes of patients in CE group and LAA group.The effectiveness index was evaluated using the modified Rankin Scale(mRS)at 90 days of onset.The safety index was the incidence of symtomatic intracerebral hemorrhage(sICH)within 7days of onset and the mortality associated with ischemic stroke within 90 days of onset.We use these two indicators to evaluate safety.According to the mRS score,patients were divided into a good prognosis group and a poor prognosis group.An mRS score of0-2 was defined as a good prognosis,and an mRS score of >2 was defined as a poor prognosis.The baseline data of patients with good prognosis and poor prognosis were compared.Multivariate logistic regression analysis was used to screen independent risk factors for poor prognosis.Results: A total of 716 patients were collected from January 2017 to June 2018 and classified according to TOAST classification criteria.There were 93 cases of cardioembolic stroke and 219 cases of large-artery atherosclerosis stroke.After excluding urokinase thrombolysis,endovascular treatment,posterior circulation stroke,patients without relevant angiography and lost follow-up,a total of 238 patients were entrolled.Among them,there were 80 cases in the CE group and 158 cases in the LAAgroup.Compared with the LAA group,the CE group had older patients and a higher proportion of atrial fibrillation,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of sICH within 7 days,the good rate of 90-day outcome,and the mortality within 90 days of the two groups(P>0.05).Of the 238 patients,47%(112)had a good prognosis,and 53%(126)had a poor prognosis.Compared with the poor prognosis group,the age,fasting blood glucose level,National Institute of Health Stroke Scale(NIHSS)scores before the thrombolysis and NIHSS scores at 24 hours after thrombolysis were significantly biased,the difference was statistically significant(P<0.05).There was no statistically significant difference in TOAST etiology between the two groups(P>0.05).The age,NIHSS score before thrombolysis,NIHSS score 24 hours after thrombolysis,and fasting blood glucose were included in the multivariate logistic regression analysis to screen for independent risk factors that affected the prognosis.Multivariate Logistic regression analysis showed that older age(OR=1.040,95% CI: 1.010?1.071,P=0.008)and higher NIHSS scores 24 hours after thrombolysis(OR=1.259,95%CI: 1.175?1.350,P=0.000)were independent risk factors for poor prognosis.Conclusions:(1)Intravenous thrombolysis was also safe and effective in patients with cardiogenic stroke,and the prognosis of thrombolysis was not related to whether the etiological type was CE or LAA;(2)Multivariate Logistic regression analysis showed that older age and higher NIHSS score 24 hours after thrombolysis were independent risk factors for poor prognosis. |
PDF Full Text Request