60岁以上急性脑梗死患者静脉溶栓后出血性转化的影响因素分析  

Influencing Factors of Hemorrhagic Transformation in Patients Over 60 Years Old with Acute Cerebral Infarction After Intravenous Thrombolysis

作　　者：张莉[1] 余小骊[1] 欧阳晓春 王水华 ZHANG Li;YU Xiaoli;OUYANG Xiaochun;WANG Shuihua(Joint Logistics Support Force 908th Hospital,Nanchang 330000,China;不详)

机构地区：[1]中国人民解放军联勤保障部队第九〇八医院,江西南昌330000

出　　处：《中国医学创新》2020年第29期69-72,共4页Medical Innovation of China

摘　　要：目的:分析60岁以上急性脑梗死患者静脉溶栓后出血性转化(HT)的影响因素,为临床预防措施提供指导。方法:选取本院2018年1月-2020年3月经静脉溶栓治疗的127例60岁以上急性脑梗死患者的临床资料进行回顾性分析。根据患者静脉溶栓治疗后HT发生情况分为HT发生组(n=34)与HT未发生组(n=93)。设计临床资料调查问卷,统计两组基本信息,分析导致60岁以上急性脑梗死患者静脉溶栓后HT的影响因素。结果:HT发生组中,心源性脑栓塞占比最高,为55.88%(19/34);其次为大动脉粥样硬化,占23.53%(8/34);小动脉闭塞型,占14.71%(5/34);其他不明因型,占5.88%(2/34)。HT发生组合并糖尿病、高同型半胱氨酸(homocysteine,Hcy)血症与脑梗死面积≥5 cm2比例均高于HT未发生组(P<0.05)。合并糖尿病、高Hcy血症、脑梗死面积≥5 cm2为导致急性脑梗死患者静脉溶栓后发生HT的影响因素(P<0.05)。结论:60岁以上急性脑梗死患者静脉溶栓治疗后心源性脑栓塞发生率最高,且合并糖尿病、高Hcy血症、脑梗死面积≥5 cm2为导致60岁以上急性脑梗死患者静脉溶栓后发生HT的影响因素,临床需积极予以对症治疗措施,以期降低HT发生率。Objective:To analyze the influencing factors of hemorrhagic transformation of(HT)in patients over 60 years old with acute cerebral infarction after intravenous thrombolysis,and provide guidance for clinical preventive measures.Method:The clinical data of 127 patients over 60 years old with acute cerebral infarction treated with intravenous thrombolysis in our hospital from January 2018 to March 2020 were retrospectively analyzed.According to the occurrence of HT after intravenous thrombolytic therapy,all patients were divided into HT group(n=34)and HT non-occurrence group(n=93).The clinical data questionnaire was designed,the basic information of the two groups was statistically analyzed,and the influencing factors of HT after intravenous thrombolysis in over 60 years old patients with acute cerebral infarction were analyzed.Result:In HT group,cardiogenic cerebral embolism accounted for 55.88%(19/34),followed by large artery atherosclerosis accounted for 23.53%(8/34),small artery occlusion accounted for 14.71%(5/34),and other unknown causes accounted for 5.88%(2/34).The proportion of combined with diabetes mellitus,hyperhomocysteinemia and cerebral infarction area≥5 cm^2 of the HT group were higher than those of the HT non-occurrence group(P<0.05).Diabetes mellitus,hyperhomocysteinemia and cerebral infarction area≥5 cm^2 were the influencing factors of HT after intravenous thrombolysis(P<0.05).Conclusion:The incidence of cardiogenic cerebral embolism is the highest in patients over 60 years old patients with acute cerebral infarction after intravenous thrombolytic therapy,and diabetes mellitus,hyperhomocysteinemia and erebral infarction area≥5 cm^2 are the influencing factors of HT in patients over 60 years old with acute cerebral infarction after intravenous thrombolysis.Clinically,positive symptomatic treatment measures should be taken in order to reduce the incidence of HT.

关 键 词：急性脑梗死 静脉溶栓 出血性转化 

分 类 号：R743.33[医药卫生—神经病学与精神病学]