脑卒中患者静脉溶栓24小时内血压与出血的相关性研究  

Association between 24-hour blood pressure and bleeding complications in patients underwent intravenous thrombolysis

作　　者：赵洁[1] 常红[1] 王晓娟[1] 张佳佳 姚辉[1] Jie ZHAO;Hong CHANG;Xiaojuan WANG;Jiajia ZHANG;Hui YAO

机构地区：[1]首都医科大学宣武医院神经内科

出　　处：《中华护理杂志》2019年第7期981-984,共4页Chinese Journal of Nursing

基　　金：北京市医院管理局临床医学发展专项经费(扬帆计划)(ZYLX201706);北京市科委首都临床特色应用研究项目(Z171100001017027);北京市医管局“市属医院职工科技创新工场培育团队”(2017);北京市卫生科技成果与适宜技术推广项目资助(2018-TG-53);首都医科大学宣武医院院级护理专项(XWHL-2017002)

摘　　要：目的监测、分析急性缺血性脑卒中患者静脉溶栓24 h内血压水平与溶栓后出血的相关性,旨在得出各出血部位对应的血压预测值及测量时间。方法纳入2015年6月—2017年12月北京市4所高级卒中中心的急性缺血性脑卒中静脉溶栓患者487例,记录患者的人口学资料、溶栓前血压、溶栓后24 h内血压及发生出血时的影像学和实验室检查结果。绘制受试者操作特征曲线,计算Youden指数最大的血压分界点及监测时间点。结果 168例(34.5%)发生不同部位的溶栓后出血。出血患者血压高于非出血患者,差异具有统计学意义(P<0.05)。全身出血、颅内出血、牙龈出血的发生时间为溶栓前或溶栓时,呼吸道出血的发生时间为溶栓后早期,鼻和泌尿系统出血的发生时间为溶栓后12 h左右。不同部位发生出血的血压预警值分别为:全身出血146/81.5 mmHg(1 mmHg=0.133 kPa),颅内出血159.5/108.5 mmHg,牙龈出血159.5/85 mmHg,鼻出血184/87.5 mmHg,呼吸道出血143.5/100.5 mmHg,泌尿系统出血136.5/91.5 mmHg。结论溶栓后24 h内高血压是静脉溶栓后出血的危险因素,各出血部位对应的血压预测值及测量时间可为护理观察的重点提供依据。Objective To monitor and analyze the association between 24-hour blood pressure and bleeding complications in patients with acute ischemic stroke after intravenous thrombolysis,for predicting bleeding complications with possible blood pressure range and monitoring time.Methods Totally 487 patients with acute ischemic stroke who were admitted to four stroke centers in Beijing from June 2015 to December 2017 were enrolled and received rt-PA intravenous thrombolysis. Demographic data,blood pressure before thrombolysis,blood pressure within 24 hours after thrombolysis,imaging examination during bleeding,and laboratory inspection data were collected and analyzed.Results A total of 168 patients(34.5%) had bleeding complications. The baseline blood pressure of patients with bleeding complications was higher than that of patients with non-bleeding complications,and the difference was statistically significant(P<0.05). The optimal blood pressure monitoring time for systemic hemorrhage,intracranial hemorrhage and gingival hemorrhage was before thrombolysis or during thrombolysis. Respiratory hemorrhage occurred early after thrombolysis,while nasal and urinary hemorrhage occurred about 12 hours after thrombolysis. The threshold values of blood pressure were 146/81.5 mmHg(systemic hemorrhage),159.5/108.5 mmHg(intracranial hemorrhage),159.5/85 mmHg(gingival hemorrhage),184/87.5 mmHg(nasal hemorrhage),143.5/100.5 mmHg(respiratory hemorrhage),136.5./91.5 mmHg(urinary hemorrhage),respectively.Conclusion High blood pressure within 24 hours after thrombolysis is risk factor for hemorrhage. Bleeding complications with possible blood pressure range and monitoring time provide basis for nursing observation.

关 键 词：急性缺血性脑卒中 静脉溶栓 血压 溶栓后出血 

分 类 号：R473.74[医药卫生—护理学]