缺血性腦中風病人使用血栓溶解劑後嚴重度改變量之相關因素研究

Related Factors of Severity Change in Ischemic Stroke Patients After Using Thrombolytic Agents

血栓溶解劑被用來治療急性缺血性腦中風，本研究目的為探討加護中心缺血性腦中風病人使用血栓溶解劑後嚴重度改變量之相關因素。採回溯式研究法，收集某醫學中心腦中風資料庫2007年2月至2012年1月共5年的病人資料，以腦中風評估量表為評估工具，有效樣本73份。研究結果顯示糖尿病(t=3.9，p<.001)、合併症(t=5.9，p<.001)、顱內出血(t=2.1，p<.05)、顱內壓升高(t＝6.5，p<.001)、服用Coumadin(t=-2.0，p<.05)等因素，皆與嚴重度改變量達統計上顯著差異。而急診高血糖(r=-.47，p<.001)、注射後七天評估NIHSS量表分數(r=-.90，p<.001)，則與治療嚴重度改變量呈現具統計意義的負相關。因此，建議需注意中風初期嚴密控制血糖值在110mg/dl以內；早期辨識及診治顱內出血及顱內壓升高；針對服用Coumadin病人需預防出血，以減少合併症及神經功能惡化，提升療效達到缺血性腦中風治癒的目的。

Intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) has been used to treat for acute ischemic stroke. The purpose of this study was investigated related factors of change severity in intensive care unit patients with ischemic stroke after using thrombolytic agents. A sample spanning 5 years from February 2007 to January 2012 was drawn from the stroke database of a medical center. The retrospective cohort study method and the National Institutes of Health Stroke Scale (NIHSS) were employed. A total of 73 valid samples were obtained. The change severity of ischemic stroke analysis of the therapy varied signifi cantly, including diabetes (t = 3.9, p < .001), occurrence of complication (t = 5.9, p < .001), intracranial hemorrhaging (t = 2.1, p < .05), increased intracranial pressure (t = 6.5, p < .001), and use of Coumadin (t = -2.0, p < .05). In addition, factors including emergency room hyperglycemia (r = -.47, p < .001), and NIHSS rating upon 7 days after injection (r = -.90, p < .001) were negatively related to the therapy effect analysis. Attention should be focused on initial stroke and tight control of blood glucose values to less than 110mg/dl, early identification and treatment of intracranial bleeding and increased intracranial pressure, and use of Coumadin to prevent bleeding and improve of healing.