【摘要】 目的 研究急性缺血性脑卒中（AIS）患者行阿替普酶静脉溶栓治疗与吸烟的关系，进行安全性及有效性分析。方法 收集天津市环湖医院神经内科四病区2024年1月至2024年12月期间行静脉溶栓的急性缺血性脑卒中患者197例作为研究对象，患者发病至静脉溶栓时间在4.5 h内，分为吸烟组103例与非吸烟组94例，进行回顾性分析。分析各组患者入院时、溶栓1 h、溶栓24 h及7 d的美国国立卫生研究院卒中量表（NIHSS）评分，治疗后3个月的改良神经功能评估量表（Rankin）评分，分析溶栓后24 h不良事件发生情况。结果 吸烟组静脉溶栓治疗后1 h、溶栓24 h及7 d的NIHSS评分水平较非吸烟组明显下降（P<0.05）。治疗3个月时远期预后良好率吸烟组（96.12%）明显高于非吸烟组（86.17%），差异具有统计学意义（P<0.05）。溶栓后24 h颅内出血方面，吸烟组为4例（3.8%），非吸烟组为5例（5.3%），差异无统计学意义（P > 0.05）。两组之间症状性颅内出血的发生率与死亡率比较差异无统计学意义。结论 急性缺血性脑卒中患者行静脉溶栓后，治疗效果吸烟组优于非吸烟组，但未观察到吸烟与颅内出血风险/死亡率的显著关联。吸烟是脑卒中明确的危险因素，其导致的动脉粥样硬化对阿替普酶更敏感，另吸烟患者年轻、基础疾病较少，从而显得其静脉溶栓后预后更好。更多还原

【Abstract】 Objective To study the relationship between intravenous thrombolysis with alteplase and smoking in patients with acute ischemic stroke(AIS), and conduct safety and effectiveness analysis. Methods A total of 197 patients with acute ischemic stroke who underwent intravenous thrombolysis in the Fourth Ward of Neurology Department, Tianjin Huanhu Hospital from January 2024 to December 2024, time from symptom onset to intravenous thrombolysis within 4.5 hours, were collected as research subjects. They were divided into a smoking group(103 cases) and a non-smoking group(94 cases) for retrospective analysis. Analyze the National Institutes of Health Stroke Scale(NIHSS) scores of patients in each group at admission, 1 hour after thrombolysis, 24 hours after thrombolysis, and 7 days after thrombolysis, as well as the modified Rankin scale scores at 3 months after treatment. Also, analyze the differences in the occurrence of adverse events within 24 hours after thrombolysis. Results The NIHSS scores in the smoking group were significantly lower than those in the non-smoking group at 1 hour, 24 hours, and 7 days after intravenous thrombolysis( P < 0.05).At 3 months after treatment, the long-term favorable prognosis rate in the smoking group(96.12%) was significantly higher than that in the non-smoking group(86.17%), and the difference was statistically significant(P< 0.05). In terms of intracranial hemorrhage within 24 hours after thrombolysis, there were 4 cases(3.8%) in the smoking group and 5 cases(5.3%) in the non-smoking group, with no statistically significant difference(P > 0.05). There was no statistically significant difference in the incidence of symptomatic intracerebral hemorrhage and mortality rate between the two groups. Conclusion In patients with acute ischemic stroke who underwent intravenous thrombolysis, the therapeutic effect was better in the smoking group than in the non-smoking group. In this study, no significant association was observed between smoking and the risk of intracranial hemorrhage or mortality. Smoking is a well-established risk factor for stroke. Atherosclerosis caused by smoking is more sensitive to alteplase. Additionally, smoking patients are generally younger and have fewer underlying diseases, which collectively makes the prognosis of smoking patients better after intravenous thrombolysis.更多还原