大面积脑梗死静脉溶栓后脑出血转化发生情况及危险因素  

Risk factors of cerebral hemorrhage transformation in patients with massive cerebral infarction after intravenous thrombolysis

作　　者：范贵娜 万东升 孙丽萍 FAN Guina;WAN Dongsheng;SUN Liping(Pingdingshan Second People’s Hospital,Pingdingshan 467000,China)

机构地区：[1]平顶山市第二人民医院,河南平顶山467000

出　　处：《中国实用神经疾病杂志》2021年第18期1634-1641,共8页Chinese Journal of Practical Nervous Diseases

摘　　要：目的分析大面积脑梗死静脉溶栓后脑出血转化(HT)发生情况及危险因素。方法选取2018-06—2021-06于平顶山市第二人民医院进行静脉溶栓治疗的大面积脑梗死患者158例,所有患者接受重组组织纤溶酶原激活剂(rt-PA)进行溶栓治疗,观察患者溶栓后HT发生情况,并将发生HT的患者设为HT组,其余患者为对照组,比较2组患者临床资料差异,筛选出可能导致患者溶栓后HT的危险因素,并通过Logistic回归分析进一步确定其危险因素。结果经rt-PA溶栓后,158例患者中43例(27.22%)发生HT,剩余115例(72.78%)未发生HT;2组发病至溶栓时间、是否合并糖尿病、溶栓前血糖水平、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、是否存在房颤、溶栓后1 h收缩压等比较,差异均有统计学意义(P<0.05);经多因素Logistic回归分析,发病至溶栓时间>3 h、溶栓前NIHSS评分>15分、存在房颤及溶栓后1 h收缩压>90 mmHg(1 mmHg=0.133 kPa)是导致大面积脑梗死患者静脉溶栓后发生HT的独立危险因素(P<0.05)。结论影响大面积脑梗死患者静脉溶栓后发生HT的独立危险因素有发病至溶栓时间、溶栓前NIHSS评分、房颤及溶栓后1 h收缩压,临床应采取相应针对性措施,以避免溶栓后HT的发生。Objective To explore the occurrence and risk factors of cerebral hemorrhage transformation(HT)in patients with massive cerebral infarction after intravenous thrombolysis.Methods A total of 158 patients with massive cerebral infarction who underwent intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in the hospital were selected between June 2018 and June 2021.According to presence or absence of HT,the patients were divided into HT group and control group.Clinical data of the two groups were compared to screen possible risk factors for HT after thrombolysis.The risk factors were determined by Logistic regression analysis.Results After thrombolysis with rt-PA,43(27.22%)of the 158 patients developed HT.There were statistically significant differences between the HT group and the control group in terms of the time from onset to thrombolysis,diabetes,blood glucose level before thrombolysis,the National Institutes of Health Stroke Scale(NIHSS)score before thrombolysis,atrial fibrillation,and systolic blood pressure at 1h after thrombolysis(P<0.05).Multivariate Logistic regression analysis found that the time from onset to thrombolysis>3h,NIHSS score>15 before thrombolysis,atrial fibrillation and systolic blood pressure>90mmHg at 1h after thrombolysis were independent risk factors for HT in patients with massive cerebral infarction after intravenous thrombolysis(P<0.05).Conclusion Thetime from onset to thrombolysis,NIHSS scorebefore thrombolysis,atrial fibrillation and systolic blood pressure at 1h after thrombolysis are independent risk factors for HT in patients with massive cerebral infarction after intravenous thrombolysis.Clinically,targeted measures should be taken to prevent the occurrence of HT after thrombolysis.

关 键 词：大面积脑梗死 静脉溶栓 重组组织纤溶酶原激活剂 脑出血转化 危险因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]