急性缺血性卒中患者静脉溶栓后谵妄与90天功能结局之间的关联。
Association between post-intravenous thrombolysis delirium and 90-day functional outcomes in patients with acute ischemic stroke.
文献信息
| PMID | 42756852 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yanan Hao |
| 作者单位 | JiaXing Key Laboratory of Fundamental and Clinical Research on Cerebral Protection in Acute Ischemic Cerebrovascular Disease (A), Department of Neurology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China. |
| 期刊 | Frontiers in psychiatry |
| SCI 分区 | Q2 |
| IF | 4.4 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 本研究旨在探讨急性缺血性卒中（AIS）患者静脉溶栓后谵妄与90天功能结局之间的关联。
方法： 回顾性分析2023年1月1日至2024年12月31日期间因AIS在症状发作24小时内入住嘉兴市第二医院并接受静脉溶栓的患者。收集临床数据以评估与再灌注后谵妄发生相关的因素。采用改良Rankin量表评估90天功能结局，评分0-2分为良好，3-6分为不良。进行多因素logistic回归分析，以确定再灌注后谵妄发生和90天功能结局不良的独立危险因素。
结果： 共纳入272例患者，其中男性173例，女性99例，平均年龄67.27±11.74岁。42例患者发生谵妄，发生率为15.4%。吞咽困难（OR 22.695，95% CI 9.853至52.135，P<0.001）、继发感染（OR 18.039，95% CI 8.713至37.351，P<0.001）和低蛋白血症（OR 9.168，95% CI 4.514至18.618，P<0.001）是急性脑梗死患者发生谵妄的强独立危险因素。年龄、文盲、基线NIHSS评分升高、使用镇静药物以及TOAST分型为大动脉粥样硬化型/心源性栓塞型会显著增加谵妄风险，且谵妄与短期死亡风险高度相关。谵妄是脑梗死后90天功能预后不良的强独立危险因素（OR=12.356，95% CI 5.892至26.008，P<0.001）。同时，年龄增加、高血压、入院后多种合并症（电解质紊乱、贫血、低蛋白血症、吞咽困难、继发感染等）、基线NIHSS评分升高以及TOAST分型为大动脉粥样硬化型/心源性栓塞型也会显著增加患者脑梗死后90天功能预后不良的风险。
结论： 在接受静脉溶栓治疗的AIS患者中，谵妄与90天功能结局不良显著相关，凸显了早期识别谵妄的临床重要性。吞咽困难、继发感染、低蛋白血症、高基线NIHSS评分以及大动脉粥样硬化型和心源性栓塞型卒中亚型与谵妄发生和90天不良结局均独立相关。
英文摘要
OBJECTIVE: This study aimed to examine the association between post-Intravenous thrombolysis delirium and 90-day functional outcomes in patients with acute ischemic stroke (AIS).
METHODS: Patients admitted to the Second Hospital of Jiaxing within 24 hours of symptom onset who underwent intravenous thrombolysis for AIS between January 1, 2023, and December 31, 2024, were retrospectively analyzed. Clinical data were collected to evaluate factors associated with the occurrence of post-reperfusion delirium. Functional outcomes at 90 days were assessed using the modified Rankin Scale, with scores of 0-2 classified as favorable and scores of 3-6 classified as poor. Multivariate logistic regression analyses were performed to identify independent risk factors for the development of post-reperfusion delirium and unfavorable 90-day functional outcomes.
RESULTS: A total of 272 patients were included, comprising 173 males and 99 females, with a mean age of 67.27 ± 11.74 years. Delirium developed in 42 patients, corresponding to an incidence rate of 15.4%. Dysphagia (OR 22.695, 95% CI 9.853 to 52.135, P < 0.001), secondary infection (OR 18.039, 95% CI 8.713 to 37.351, P < 0.001), and hypoproteinemia (OR 9.168, 95% CI 4.514 to 18.618, P < 0.001) were strong independent risk factors for delirium in acute cerebral infarction. Age, illiteracy, increased baseline NIHSS score, the use of sedative drugs, and TOAST classification as large artery atherosclerosis type/cardiogenic embolism type would significantly increase the risk of delirium, and delirium was highly correlated with short-term mortality risk. Delirium was a strong independent risk factor for poor functional prognosis 90 days after cerebral infarction (OR = 12.356, 95% CI 5.892 to 26.008, P < 0.001). At the same time, increasing age, hypertension, multiple comorbidities after admission (electrolyte imbalance, anemia, hypoproteinemia, dysphagia, secondary infection, etc.), increased baseline NIHSS score, and TOAST classification as large artery atherosclerosis type/cardiogenic embolism type would also significantly increase the risk of poor functional prognosis 90 days after cerebral infarction in patients.
CONCLUSION: Delirium is significantly associated with poor functional outcomes at 90 days in patients with AIS treated with intravenous thrombolysis, highlighting the clinical importance of early delirium detection. Dysphagia, secondary infections, hypoproteinemia, high baseline NIHSS scores, and large-artery atherosclerotic and cardioembolic stroke subtypes are independently associated with both delirium occurrence and adverse 90-day outcomes.