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在急性缺血性中风患者的静脉输血栓溶解期间非常早期的神经系统恶化
Ying-Chi Shen1, Shin-Joe Yeh1, Chih-Hao Chen1
1Stroke Center and Department of Neurology, National Taiwan University Hospital, Taiwan.
Journal of the Formosan Medical Association = Taiwan yi zhi
|August 29, 2024
概括
在急性缺血性中风 (AIS) 患者的组织等离子素激活剂 (tPA) 输注期间非常早期的神经系统恶化预测结果不佳. 血管内血栓切除术可能会改善那些经历VEND的人的结果.
科学领域:
- 神经学 神经学
- 心血管医学 心血管医学
- 紧急医疗 紧急医疗
背景情况:
- 用组织等离子体激活剂 (tPA) 进行静脉血栓溶解后24小时内的神经状况恶化与急性缺血性中风 (AIS) 患者的不良结果有关.
- 这项研究调查了神经系统恶化的特征,特别是在tPA输注期间发生.
研究的目的:
- 在AIS患者的tPA输注期间识别神经系统恶化的特征.
- 确定非常早期神经衰退 (VEND) 与功能结果之间的关联.
- 探索内血管血栓切除术 (EVT) 在管理VEND.
主要方法:
- 在2018年1月至2021年12月期间接受tPA的AIS患者的分析.
- 在tPA输注期间,VEND的定义是国家卫生研究院中风量表 (NIHSS) 增加≥4点.
- 使用修改的兰金尺度 (mRS) 三个月的得分来评估功能不良的结果.
主要成果:
- 在接受tPA的345名AIS患者中,8.4%的患者经历了VEND,主要是由于缺血性进展.
- VEND与内动脉样硬化疾病 (41%对17%) 的更高患病率有关.
- 在轻微和非轻微中风组中,VEND独立预测了功能不良的结果. 轻微中风和VEND患者更有可能接受EVT (38%vs5%).
- 在VEND后的EVT患者中,成功的再化与24小时NIHSS得分较低和3个月后更好的结果相关.
结论:
- 非常早期的神经系统恶化 (VEND) 是急性缺血性中风 (AIS) 患者功能表现不佳的预测因素.
- 通过内血管血栓切除术 (EVT) 及时并成功地进行再通道,可以减轻VEND对长期结果的不良影响.
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