中国实用神经疾病杂志2026，Vol.29Issue(10)：1226-1232,7.DOI:10.12083/SYSJ.251022
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
Predictive value of cerebral hemodynamics combined with dynamic cerebral oxygen metabolism monitoring for neurological function of patients with acute ischemic stroke after intravenous thrombolysis
摘要
Abstract
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.关键词
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Key words
Acute ischemic stroke/Intravenous thrombolysis/Cerebral oxygen metabolism/Near-infrared spectroscopy/Transcranial Doppler ultrasound/Neurological function/Prognosis分类
医药卫生引用本文复制引用
张鹏,徐晨阳,刘志军,耿亚东,刘红林..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[J].中国实用神经疾病杂志,2026,29(10):1226-1232,7.基金项目
河南省医学科技攻关计划项目(编号:LHGJ20240401) （编号:LHGJ20240401）
