Early Curative Effect Of Intravenous Thrombolysis In Acute Cerebral Infarction And Its Influencing Factors

Objective: To clarify the early efficacy and influencing factors of patients with acute cerebral infarction who received or did not receive intravenous thrombolysis within 4.5h of onset.Methods: The clinical data of 102 patients with Acute cerebral infarction(ACI)admitted to Department of Neurology,Second People’s Hospital of Yueyang City,Hunan Province from January 2019 to December 2020 were analyzed retrospectively.According to the approval of Intravenous thrombolysis(IVT),53 patients were divided into thrombolytic group(TG)and 49 patients were non thrombolytic group(NTG).The Recombinant tissue plasminogen activator(rt-PA)was given to the TG group.All thrombolytic patients were transferred to the stroke ward or intensive care unit and followed by a neurologist for at least 24 hours for neurological dysfunction.If the patient developed headache,nausea,or vomiting within 24 hours or NIHSS score increased by≥4points,the head imaging examination was immediately reexamined.Patients were divided into brain computermography(CT)and brain magnetic resonance imaging(MRI)according to their conditions,24 h after IVT,the head imaging examination was reexamined,and aspirin/clopidogrel sulfate tablets were given antiplatelet therapy after no bleeding was confirmed.Patients with cardiogenic embolism were treated with standard anticoagulant therapy according to "1.3.6.12".The NTG group was given antiplatelet therapy with aspirin/clopidogrel bisulfate tablets,and patients with cardiogenic embolism were given standard anticoagulant therapy according to the principle of "1.3.6.12".and both groups were supplemented with brain protectant and symptomatic supportive therapy.The early nervous system status of each patient after thrombolysis was reviewed in detail,including NIHSS scores before,24 hours,7 days after thrombolysis,and early neurological deterioration(END),24 hours,7days after thrombolysis.NTG record therapy after 7 days,14 days after the antiplatelet therapy of NIHSS score and END,at this time to finish demographic variables,relevant factors and laboratory data,analysis in the time window have IVT and venous thrombolysis treatment the clinical results within patients who have acute cerebral infarction as well as influencing elements for early treatment effect.Use SPSS26.0 to comprehensively analyze the collected data.The measurement data adopts mean±standard deviation for t test.Data that does not conform to the normal distribution adopts the rank sum test,which was expressed as median ± quartile difference.The x2 test had been adopted for comparing the counting information.The elements that influence the primary prognostic elements of thrombolysis had been explored by Logistics regression analysis,(P < 0.05)indicating that the difference is statistically significant.Results:A total of 102 ACI patients meeting the criteria were selected,including 42 females and 60 males,aged 45 to 90 years,with an average age of 68.56±10.57 years.1.Analysis of the efficacy of thrombolysis:The NIHSS score before IVT was 10.51±8.66 in 53 patients in the TG,and 10.73±3.01 in 49 patients in the NTG.There was no significant difference between the two groups(P > 0.05).Comparison of NIHSS scores of the TG group and the NTG group at 24 h and 7d after receiving the corresponding treatment showed that the statistical values were(Z=-1.853,P=0.064)and(Z=-3.549,P=0.000)respectively.There was statistical significance between 7 days after treatment and before treatment(P < 0.05).In the TG,37 patients received thrombolysis within 3h,and the NIHSS score was10.92±8.94 points before IVT.Among them,16 patients received IVT within 3～4.5h.The NIHSS score before IVT was 9.36±8.03.There was no difference in comparision between the two groups(P > 0.05).The NIHSS scores were(Z=-1.308,P=0.191)at 1 week after thrombolysis in the3～4.5h group,respectively,and the comparison of two groups was not statistically meaningful(P > 0.05).2.Early neurological deterioration(END)during thrombolytic therapy.The incidence of END events in patients with acute cerebral infarction was taken as the dependent variable.The history of cerebral infarction and TOAST classification were used as independent variables.After research and analysis,we found that large atherosclerosis was an important risk factor for the increase in the incidence of END events(P < 0.05),and the history of cerebral infarction was not an influencing factor for the occurrence of END events in ACI patients(P >0.05).Bleeding after thrombolytic therapy:The number of cases of intracranial hemorrhage was 5 and 1 in TG and NTG,respectively.In the TG,Intracranial hemorrhage occurred in 3 case in the 3-hour group,and 2cases of intracranial hemorrhage occurred in the 3～4.5 hour group.The two groups’ difference wasn’t statistically important(P=0.624,x=0.494).The incidence of bleeding(including intracranial,oral,skin,and mucosal bleeding)in both the TG and NTG.The incidence of hemorrhage was 15.09% in the TG and 4.08% in the NTG.It was not any significant differences in intracranial hemorrhage,oral mucosa hemorrhage,gingival hemorrhage and skin ecchymosis between the two groups.Multivariate Analysis of early prognosis: It showed that History of hypertension was an independent influencing factor for early efficacy,and history of hypertension was a risk factor affecting the early clinical prognosis of IVT patients.3.Clinical Outcomes:A total of 7 patients died,including 5 in the TG and 2 in the NTG,the mortality rates were 9.43% and 4.08%,respectively.Before thrombolysis,the NIHSS scores of the dead patients and the surviving patients in the TG group were 17.43±10.36,and10.12±5.96 respectively,presenting a significant difference(t=0.004,P=0.004).Patients who survived in the TG group showed no significant differences in diabetes history,admission blood glucose,END after thrombolysis and other aspects(P > 0.05).Conclusion:1.The therapeutic efficacy in the intravenous thrombolysis group was better than that in non-intravenous thrombolysis group,and the efficacy of intravenous thrombolysis within 3h and 3-4.5h was the same.2.The slightly higher intracerebral hemorrhage rate after thrombolysis in the TG group may be related to poor blood pressure control in the early stage of intravenous thrombolysis,suggesting that hypertension is one of the factors affecting the transformation of bleeding in the early stage of intravenous thrombolysis.This study has certain reference value for clinical work.