急性脑梗死静脉溶栓前后美国国立卫生研究院卒中量表评分与收缩压变化值在颅内出血性转化中的预测价值  

Analysis of difference value in NIHSS score and blood pressure before and after intravenous thrombolysis in the prediction of hemorrhage transformation in acute ischemic stroke patients

作　　者：徐阳[1] 金凡夫 赵丽 黄四妹 赵守财[1] 刘海荣 储照虎[1] XU Yang;JIN Fanfu;ZHAO Li;HUANG Simei;ZHAO Shoucai;LIU Hairong;CHU Zhaohu(Department of Neurology,Yijishan Hospital of Wannan Medical College,Wuhu,Anhui 241000,China;School of Humanities and Management,Wannan Medical College,Wuhu,Anhui 241000,China)

机构地区：[1]皖南医学院弋矶山医院神经内科,安徽芜湖241000 [2]皖南医学院人文与管理学院,安徽芜湖241000

出　　处：《安徽医药》2021年第2期250-254,共5页Anhui Medical and Pharmaceutical Journal

基　　金：国家自然科学基金项目(81701161)。

摘　　要：目的探索缺血性卒中静脉溶栓病人,出现颅内出血转化的危险因素。方法收集分析2018年1月1日至2019年11月30日在皖南医学院弋矶山医院接受静脉溶栓治疗的123例急性脑梗死临床资料。溶栓24 h后采用头颅CT检查。将病人分为出血转化组(n=25)和非出血转化组(n=98)。对比两组年龄、性别、吸烟史、饮酒史、溶栓前后病人收缩压和舒张压变化,发病到病人接受静脉溶栓治疗的时间,溶栓前后美国国立卫生研究院卒中量表(NIHSS)评分变化等,明确脑梗死病人行溶栓治疗后出血转化的危险因素。结果两组在性别、烟酒史、发病到接受溶栓治疗时间等基线数据上差异无统计学意义(P>0.05);出血转化组与非出血组在发病年龄[(71.64±10.56)岁比(63.85±12.42)岁]、溶栓前NIHSS评分[11(6,14.5)分比7(4,12)分]、溶栓后2 h NIHSS评分[11(3,14.5)分比5(2,9)分],出血转化组均大于非出血组(P<0.05)。但是出血转化组溶栓前后NIHSS评分差值低于非出血组[0(0,2)分比1(0,4)分,P<0.001]、溶栓前收缩压出血转化组较高[(160.88±20.24)mmHg比(150.79±21)mmHg,P=0.033],出血转化组溶栓前后收缩压变化值大于非出血转化组[(34.88±22.51)mmHg比(24.58±16.56)mmHg,P=0.011]。logistic逐步回归分析提示年龄较大、溶栓前后收缩压差值、溶栓前后NIHSS评分变化值是脑梗死病人溶栓治疗后出血转化的危险因素(P>0.05)。溶栓前后收缩压变化值和NIHSS评分变化值均对病人愈后有显著影响(P>0.05)。结论静脉溶栓后NIHSS评分变化值小、溶栓后收缩压变化值大是出血转化的危险因素。尤其是高龄病人,应充分考虑到病人血压情况和神经功能缺损程度等变化因素,并采用合适的干预手段、积极预防出血转化的发生。Objective To analyze hemorrhage transformation prognostic factors after intravenous thrombolysis in acute ischemic stroke.Methods One hundred and twenty-three patients with acute ischemic stroke who treated by intravenous thrombolysis at Yijishan Hospital of Wannan Medical College from January 1,2018 to November 31,2019 were collected and analyzed.Twenty-four hours after thrombolysis,head CT examination was used to determine whether patients with intravenous thrombolysis had hemorrhagic transformation.The patients were assigned into hemorrhage transformation(HT)group with 25 patients and non-HT group with 98 patients.The age,sex,smoking and alcohol history,thrombolysis time,systolic blood pressure(SBP)and diastolic blood pressure(DBP)before and after thrombolysis were compared between the two groups,the time from onset to the patient receiving intravenous thrombolysis,and National Institutes of Health Stroke Scale(NIHSS)score before thrombolysis were compared,and patients with cerebral infarction risk factors for hemorrhagic transformation after thrombolytic therapy were identified.Results No significant differences in gender,smoking,and alcohol history,and thrombolysis time(P>0.05).Age[(71.64±10.56)vs.(63.85±12.42)],SBP before thrombolysis,the change of SBP before and after thrombolysis,the NIHSS score before thrombolysis[11(6,14.5)vs.7(4,12)],the NIHSS score 2 hours after thrombolysis[11(3,14.5)vs.5(2,9)],and the change of NIHSS score during thrombolysis in the HT group were higher than those in the non-HT(P>0.05).However,the difference in the NIHSS score of thrombolysis in the hemorrhagic transformation group was lower than that in the non-HT group[0(0,2)vs.1(0,4),P<0.001],pre-thrombotic SBP was higher in HT group[(160.88±20.24)mmHg vs.(150.79±21)mmHg,P=0.033].Changes in SBP before and after thrombolysis in the hemorrhagic transformation group were higher than those in the non-HT group[(34.88±2.2..51)mmHg vs.(24.58±16.56)mmHg,P=0.011].Logistic stepwise regression analysis showed that older age,systolic b

关 键 词：脑梗死 病人病情 溶栓治疗 出血转化 收缩压 美国国立卫生研究院卒中量表评分 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]