脑血流动力学联合动态脑氧代谢监测对急性缺血性脑卒中患者静脉溶栓后神经功能的预测价值OA
Predictive value of cerebral hemodynamics combined with dynamic cerebral oxygen metabolism monitoring for neurological function of patients with acute ischemic stroke after intravenous thrombolysis
目的 探讨脑血流动力学指标联合动态脑氧代谢监测参数对急性缺血性脑卒中患者静脉溶栓后神经功能恢复的预测价值.方法 回顾性分析2022-01-2024-01在河南大学淮河医院接受静脉溶栓治疗的 120 例急性缺血性脑卒中患者的临床资料.采用经颅多普勒超声(TCD)和近红外光谱(NIRS)技术监测脑血流动力学和脑氧代谢参数,包括大脑中动脉平均血流速度(MCA-Vm)、脑血氧饱和度(rSO2)、脑组织氧摄取分数(OEF)和脑组织氧代谢率(CMRO2).根据治疗3个月后改良Rankin量表(mRS)评分将患者分为良好预后组(mRS≤2分,n=72)和不良预后组(mRS>2分,n=48).分析2组患者的一般资料、临床特征、实验室检查、影像学检查及动态脑氧代谢监测参数,采用多因素Logistic回归分析确定预测神经功能恢复的独立因素.结果 2组患者溶栓后6 h MCA-Vm无统计学差异(P>0.05),rSO2显著升高(P<0.05),OEF显著降低(P<0.05),CMRO2 维持较稳定水平.多因素Logistic回归分析显示,基线NIHSS评分、中性粒细胞比例、降钙素原(PCT)及溶栓后6h rSO2、OEF、CMRO2 变化率是预测静脉溶栓后神经功能恢复的独立因素(P<0.05).受试者工作特征(ROC)曲线分析显示,溶栓后 6 h rSO2、OEF、CMRO2变化率及联合检测对神经功能恢复有显著预测价值(P<0.05),其中联合预测的敏感度(80.32%)与特异度(78.89%)最优,曲线下面积(AUC)为0.826.结论 脑血流动力学指标MCA-Vm和动态脑氧代谢监测参数rSO2、OEF、CMRO2对急性缺血性脑卒中患者静脉溶栓后神经功能恢复具有良好的预测价值,可用于早期评估预后并指导临床干预.
Objective To investigate the predictive value of cerebral hemodynamic indices combined with dynamic cerebral oxygen metabolism monitoring parameters for neurological recovery after intravenous thrombolysis in patients with acute ischemic stroke(AIS).Methods Clinical data of 120 AIS patients who received intravenous thrombolysis at the Affiliated Huaihe Hospital of Henan University from January 2022 to January 2024 were retrospectively analyzed.Transcranial Doppler(TCD)and near-infrared spectroscopy(NIRS)were used to monitor cerebral hemodynamic and oxygen metabolism parameters,including mean flow velocity of the middle cerebral artery(MCA-Vm),regional cerebral oxygen saturation(rSO2),oxygen extraction fraction(OEF),and cerebral metabolic rate of oxygen(CMRO2).Patients were divided into good prognosis group(modified Rankin scale(mRS)score≤2 at 3 months post-treatment,n=72)and poor prognosis group(mRS score>2,n=48).Differences in general information,clinical characteristics,laboratory tests,imaging findings,and dynamic cerebral oxygen metabolism parameters were analyzed between the two groups.Multivariate Logistic regression was performed to identify independent predictors of neurological recovery.Results At 6 hours post-thrombolysis,no significant difference was observed in MCA-Vm between the two groups(P>0.05),while rSO2 was significantly higher(P<0.05),OEF was significantly lower(P<0.05),and CMRO2 remained stable in the good prognosis group.Multivariate Logistic regression analysis identified baseline NIHSS score,neutrophil percentage,procalcitonin(PCT),rSO2,OEF and CMRO2 change rate at 6 hours post-thrombolysis as independent predictors of neurological recovery after intravenous thrombolysis(P<0.05).ROC curve analysis revealed that rSO2,OEF,CMRO2 change rate at 6 hours post-thrombolysis,and their combined detection significantly predicted neurological recovery(P<0.001).The combined model demonstrated the highest predictive efficacy,with the sensitivity of 80.32%,the specificity of 78.89%and the area under curve(AUC)of 0.826.Conclusion Cerebral hemodynamic indices(MCA-Vm)and dynamic cerebral oxygen metabolism monitoring parameters(rSO2,OEF,CMRO2)have good predictive value for neurological recovery after intravenous thrombolysis in AIS patients,which can be utilized for early prognosis assessment and guiding clinical interventions.
张鹏;徐晨阳;刘志军;耿亚东;刘红林
河南大学淮河医院,河南 开封 475000河南大学淮河医院,河南 开封 475000河南大学淮河医院,河南 开封 475000河南大学淮河医院,河南 开封 475000河南大学淮河医院,河南 开封 475000
医药卫生
急性缺血性脑卒中静脉溶栓脑氧代谢近红外光谱经颅多普勒超声神经功能预后
Acute ischemic strokeIntravenous thrombolysisCerebral oxygen metabolismNear-infrared spectroscopyTranscranial Doppler ultrasoundNeurological functionPrognosis
《中国实用神经疾病杂志》 2026 (10)
1226-1232,7
河南省医学科技攻关计划项目(编号:LHGJ20240401)
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