血压波动对rt-PA静脉溶栓后出血转化及预后的影响研究  

Effects of blood pressure fluctuation on hemorrhagictransformation and prognosis after rt-PA intravenous thrombolysis

作　　者：李超英[1] 刘福达[1] 温骏 陈世文[1] LI Chao-ying;LIU Fu-da;WEN Jun;CHEN Shi-wen(Jiangmen Central Hospital,Jiangmen,Jiangmen,Guangdong 529300)

机构地区：[1]江门市中心医院,广东江门529300

出　　处：《赣南医学院学报》2020年第3期268-270,共3页JOURNAL OF GANNAN MEDICAL UNIVERSITY

基　　金：江门市科技计划项目(江科201698)。

摘　　要：目的:探讨血压波动对阿替普酶(rt-PA)静脉溶栓后出血转化及预后的影响。方法:选取2017年1月至2019年7月在我院行rt-PA静脉溶栓的缺血性脑卒中患者80例,按照静脉溶栓后血压波动情况将患者分为A组(夜间血压下降≤20%)、B组(夜间血压下降>20%)和C组(夜间血压>白昼血压)。比较三组欧洲急性卒中协作研究分级(ECASSⅡ);采用改良Rankin量表(mRS)评分将患者分为预后良好组(mRS评分≤2分)和预后不良组(mRS评分>2分),应用Logistic回归分析影响患者预后的危险因素。结果:A组ECASSⅡ分级优于B、C组(P<0.05);采用mRS评分将患者分为预后良好组(n=63)和预后不良组(n=17),根据多元Logistics回归分析得,血压波动、糖尿病、心脏病、发病至溶栓时间>4.5 h、既往有脑出血史是影响缺血性脑卒中患者静脉溶栓预后的危险因素(P<0.05)。结论:静脉溶栓治疗后存在血压波动的患者发生颅内出血的危险性高于血压稳定患者,且血压波动是影响rt-PA静脉溶栓患者预后的危险因素。Objective:To explore effect of blood pressure fluctuation on hemorrhagic transformation(HT)and prognosis after alteplase(rt-PA)intravenous thrombolysis(IVT).Methods:80 patients with ischemic stroke who underwent rt-PA IVT in the hospital from January 2017 to July 2019 were enrolled.According to blood pressure fluctuation after IVT,they were divided into group A(nocturnal blood pressure decreasing by not higher than 20%),group B(nocturnal blood pressure decreasing by higher than 20%)and group C(nocturnal blood pressure higher than daytime blood pressure).European Cooperative Acute Stroke StudyⅡ(ECASSⅡ)was compared among the three groups.Patients were divided into good prognosis group(mRS score not higher than 2 points)and poor prognosis group(mRS score higher than 2 points)by scores of modified Rankin scale(mRS).Logistic regression analysis was applied to analyze risk factors influencing patient prognosis.Results:ECASSⅡgrading of group A was better than that of group B and C(P<0.05).The patients were divided into good prognosis group(n=63)and poor prognosis group(n=17)by mRS scores.Multivariate Logistic regression showed that blood pressure fluctuation,diabetes,heart disease,time from onset to thrombolysis longer than 4.5h and previous history of cerebral hemorrhage were risk factor influencing IVT prognosis of patients with ischemic stroke(P<0.05).Conclusions:After IVT,risk of intracranial hemorrhage in patients with blood pressure fluctuation is higher than that in patients with stable blood pressure.And blood pressure fluctuation is a risk factor influencing prognosis of patients undergoing rt-PA IVT.

关 键 词：血压波动 静脉溶栓 出血转化 预后 

分 类 号：R543.6[医药卫生—心血管疾病]