Early Neurological Deterioration within 24 Hours after Intravenous rt-PA Therapy for Stroke Patients: The Stroke Acute Management with Urgent Risk Factor Assessment and Improvement rt-PA Registry
Early Neurological Deterioration within 24 Hours after Intravenous rt-PA Therapy for Stroke Patients: The Stroke Acute Management with Urgent Risk Factor Assessment and Improvement rt-PA Registry
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DOI：
10.1159/000339759
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发表时间：
2012-01-01
影响因子：
2.9
通讯作者：
Toyoda, Kazunori
中科院分区：
文献类型：
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作者：
Mori, Mayumi;Naganuma, Masaki;Toyoda, Kazunori
背景：溶栓后的最初24小时对于患者的状况至关重要，在此期间需要连续的神经系统评估和血压测量。这项研究的目的是确定接受静脉注射重组组织纤溶酶原激活剂（RT-PA）治疗的中风患者24小时内与早期神经系统恶化（END）相关的临床因素，并阐明了结束对3个月结果的影响。方法：在日本的10个中风中心进行了回顾性，多中心，观察性研究。总共研究了566名中风患者[211名女性，72岁+/- 12岁，中位初始NIH中风量表（NIHSS）得分为13]，用静脉内RT-PA（0.6 mg/kg Alteplase）治疗。结束被定义为NIHSS得分在24小时的4分或更高的增加，与溶栓之前的NIHSS得分相比。结果：56例患者（9.9％，18名女性，72岁+/- 10岁）存在结束，并且与较高的血糖[优势比（OR）1.17，95％置信区间（CI）1.07-1.28独立相关。 1 mmol/L增加，p <0.001]，较低的初始NIHSS得分（OR 0.92，95％CI 0.87-0.97每1分增加，P = 0.002）和内部颈动脉（ICA）闭塞（OR 5.36，95％CI 2.60-11.09，p <0.001）在多变量分析中。在最初的36小时内，从溶栓中进行的症状性颅内出血比其他患者更为常见（根据NINDS/COCHRANE方案，或10.75，95％CI 4.33-26.85，P <0.001，并且每位最高的方案，或12.90，95％CI 2.76-67.41，p = 0.002）。在3个月时，没有末端的患者的Rankin量表（MRS）得分为0-1。结束与死亡和依赖关系独立相关（MRS 3-6或20.44，95％CI 6.96-76.93，p <0.001）以及死亡（或19.43，95％CI 7.75-51.44，p <0.001），at at at at at at 3个月。结论：高血糖，较低的基线NIHSS评分和ICA闭塞在RT-PA治疗后与终点独立相关。 End与RT-PA治疗后的3个月中风结果独立相关。版权（C）2012 S. Karger AG，巴塞尔
Background: The initial 24 h after thrombolysis are critical for patients' conditions, and continuous neurological assessment and blood pressure measurement are required during this time. The goal of this study was to identify the clinical factors associated with early neurological deterioration (END) within 24 h of stroke patients receiving intravenous recombinant tissue plasminogen activator (rt-PA) therapy and to clarify the effect of END on 3-month outcomes. Methods: A retrospective, multicenter, observational study was conducted in 10 stroke centers in Japan. A total of 566 consecutive stroke patients [211 women, 72 +/- 12 years old, the median initial NIH Stroke Scale (NIHSS) score of 13] treated with intravenous rt-PA (0.6 mg/kg alteplase) was studied. END was defined as a 4-point or greater increase in the NIHSS score at 24 h from the NIHSS score just before thrombolysis. Results: END was present in 56 patients (9.9%, 18 women, 72 +/- 10 years old) and was independently associated with higher blood glucose [ odds ratio (OR) 1.17, 95% confidence intervals (CI) 1.07-1.28 per 1 mmol/l increase, p < 0.001], lower initial NIHSS score (OR 0.92, 95% CI 0.87-0.97 per 1-point increase, p = 0.002), and internal carotid artery (ICA) occlusion (OR 5.36, 95% CI 2.60-11.09, p < 0.001) on multivariate analysis. Symptomatic intracranial hemorrhage within the initial 36 h from thrombolysis was more common in patients with END than in the other patients (per NINDS/Cochrane protocol, OR 10.75, 95% CI 4.33-26.85, p < 0.001, and per SITS-MOST protocol, OR 12.90, 95% CI 2.76-67.41, p = 0.002). At 3 months, no patients with END had a modified Rankin Scale (mRS) score of 0-1. END was independently associated with death and dependency (mRS 3-6, OR 20.44, 95% CI 6.96-76.93, p < 0.001), as well as death (OR 19.43, 95% CI 7.75-51.44, p < 0.001), at 3 months. Conclusions: Hyperglycemia, lower baseline NIHSS score, and ICA occlusion were independently associated with END after rt-PA therapy. END was independently associated with poor 3-month stroke outcome after rt-PA therapy. Copyright (C) 2012 S. Karger AG, Basel