急性脑梗死患者rt-PA治疗后并发脑出血的高危因素  

High risk factors of cerebral hemorrhage in patients with acute cerebral infarction after rt-PA therapy within 24 hours

作　　者：王蕾[1] 苏勇[2] 王彬[3] 李臻琰[4] WANG Lei;SU Yong;WANG Bin;LI Zhenyan(Department of Neurology,Pengzhou People's Hospital,Pengzhou 611930,Sichuan,China;Intensive Care Unit,Pengzhou People's Hospital,Pengzhou 611930,Sichuan,China;Department of Neurology,the Sixth People's Hospital of Chengdu,Chengdu 610000,Sichuan,China;Department of Neurosurgery,Xiangya Hospital Central South University,Changsha 410008,Hunan,China)

机构地区：[1]彭州市人民医院神经内科,四川彭州611930 [2]彭州市人民医院重症医学科,四川彭州611930 [3]成都市第六人民医院神经内科,四川成都610000 [4]中南大学湘雅医院神经外科,湖南长沙410008

出　　处：《贵州医科大学学报》2021年第4期476-481,486,共7页Journal of Guizhou Medical University

基　　金：湖南省自然科学基金(2018JJ6139)。

摘　　要：目的探究急性脑梗死患者重组组织型纤溶酶原激活剂(rt-PA)治疗后并发脑出血的高危因素。方法急性脑梗塞并接受rt-PA治疗的患者56例,采用美国国立卫生研究院卒中量表(NIHSS)分析患者溶栓前、溶栓后早期(溶栓完成后24 h、72 h、5 d、7 d)、溶栓后远期(溶栓完成后1月、3月、6月)评分,用巴氏量表指数(Barthel Index)评价溶栓完成后远期的独立生活能力;根据脑出血分型判断标准,分析溶栓后36 h内脑出血发生情况,按照治疗后并发脑出血类型分为非症状出血组、症状性出血组和未并发脑出血组,分析患者临床资料;并采用Logistic回归分析法分析脑出血发生的危险因素。结果溶栓24 h时NIHSS 2~4分患者比例明显高于溶栓前,溶栓72 h时NIHSS 2~4分患者比例明显高于溶栓24 h,溶栓7 d时NIHSS 0~1分患者比例明显高于溶栓5 d时NIHSS,差异有统计学意义(P<0.05);溶栓后36 h内共有13例患者并发脑出血,其中非症状性出血8例(14.29%)、症状性出血5例(8.23%);症状性脑出血患者起病至接受溶栓时间、溶栓前收缩压、溶栓前大梗死面积、溶栓后NIHSS评分大于未并发脑出血患者(P<0.05);平均年龄过大、溶栓后24 h收缩压高是发生非症状性出血的独立危险因素(P<0.05);平均年龄过大、起病至接受溶栓时间过长、溶栓前后大梗死面积、溶栓后24 h收缩压高、溶栓后24 h NIHSS评分>4分是发生症状性出血的独立危险因素(P<0.05)。结论急性脑梗死患者rt-PA治疗后并发脑出血的独立危险因素包括平均年龄过大、溶栓后24 h收缩压高,起病至接受溶栓时间过长、溶栓前大梗死面积及溶栓后24 h NIHSS评分>4分。Objective To explore high risk factors of cerebral hemorrhage in patients with acute cerebral infarction after rt-PA therapy within 24 hours.Methods Fifty-six patients with acute cerebral infarction who received rt-PA therapy were retrospectively analyzed using the National Institutes of Health Stroke Scale(NIHSS).NIHSS scored at the following time points:before thrombolysis,early after thrombolysis(24 h,72 h,5 d,and 7 d after thrombolysis)and the long-term score after thrombolysis(1 month,3 months,and 6 months after thrombolysis).Barthel Index was used to evaluate the long-term independent living ability after thrombolysis.According to the brain hemorrhage classification criteria,the occurrence of cerebral hemorrhage within 36 hours after thrombolysis was analyzed.Based on the type of cerebral hemorrhage after treatment,patients with cerebral hemorrhage were divided into non-symptomatic hemorrhage group(n=8),symptomatic hemorrhage group(n=4)and non-complicated cerebral hemorrhage(n=43).Clinical data of the patients were analyzed.Logistic regression analysis was used to analyze the risk factors of cerebral hemorrhage.Results The proportion of patients with NIHSS score of 2 to 4 at 24 hours after thrombolysis was significantly higher than that before thrombolysis.The proportion of patients with NIHSS score of 2 to 4 at 72 hours was significantly higher than that at 24 hours of thrombolysis.The proportion of patients with NIHSS score of 0 to 1 at 7 days was significantly higher than that at 5 days of thrombolysis(P<0.05).Within 36 hours after thrombolysis,there were 13 patients with cerebral hemorrhage,8 patients with non-symptomatic hemorrhage(14.29%)and 5 patients with symptomatic hemorrhage(8.23%).The time from onset to thrombolysis,systolic blood pressure before thrombolysis,large infarct size before thrombolysis and NIHSS score after thrombolysis in patients with symptomatic cerebral hemorrhage were greater than those in patients without cerebral hemorrhage(P<0.05).Old age and high systolic blood pressure at 2

关 键 词：脑出血 危险因素 脑梗死 急性 rt-PA治疗 并发症 

分 类 号：R743.3[医药卫生—神经病学与精神病学]