摘要
目的调查分析急性脑梗死(ACI)患者接受阿替普酶静脉溶栓治疗后出血转化,即继发颅内出血的相关情况及危险因素分析。方法纳入自2018年10月—2020年3月(合计18个月)期间就诊于陕西省宝鸡市第二人民医院神经内科的ACI并行阿替普酶静脉溶栓患者(86例),回顾性收集所有患者的临床资料,包括一般信息、既往病史、合并症以及检验检查等医疗信息,统计阿替普酶静脉溶栓治疗后继发颅内出血的发生率,对比分析相关因素,并筛选其独立危险因素。结果在86例ACI患者中有16例在阿替普酶溶栓处理后出现颅内出血,发生比例为18.4%;与未出血转化ACI患者相比,其一般信息(性别和年龄)、相关病史(高血压、糖尿病、冠心病和吸烟史)以及外周血同型半胱氨酸水平等7个因素差异均无统计学意义(均P>0.05),但两组间发病至溶栓时间(ONT)、体质量指数(BMI)、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、血压(收缩压和舒张压)、空腹血糖和既往房颤病史等7个方面差异均存在统计学意义(P=0.011、0.001、0.001、<0.001、0.003、0.036、<0.001)。最后筛选出上述差异具有统计学意义的7个因素,将其纳入ACI患者阿替普酶溶栓治疗后出血转化的多因素Logistic回归模型分析,统计结果显示:存在心房颤动病史、溶栓前血压偏高尤其是收缩压升高为ACI患者静脉阿替普酶溶栓治疗后发生出血转化的独立危险因素,差异具有统计学意义(P<0.05)。结论ACI患者阿替普酶静脉溶栓治疗后发生颅内出血的独立危险因素,包括房颤病史和溶栓前收缩压为主的高血压。上述两个因素对于溶栓后出血转化均有一定的预测价值,因此,在临床工作中可结合患者具体情况密切监测并及时给予合理有效的干预可有效降低出血转化的发生风险。
Objective To investigate the risk factors for secondary intracranial hemorrhage in patients with acute cerebral infarction(ACI)after receiving intravenous thrombolytic therapy with alteplase.Methods The relative demographic and medical data were collected from 86 ACI patients who underwent intravenous thrombolytic therapy with alteplase in department of neurology of Baoji Second People’s Hospital.24 h after the intravenous thrombolytic therapy head CT was rechecked to observe if secondary intracranial hemorrhage occurred.Multivariate regression analysis was used to identify the risk factors for secondary intracranial hemorrhage.Results Head CT showed that 16 of the 86 patients(18.4%)had secondary intracranial hemorrhage after the intravenous thrombolytic therapy with alteplase(secondary intracranial hemorrhage group).The values of diastolic and systolic blood pressures,fasting blood glucose,body mass index(BMI),National Institutes of Health Stroke Scale(NIHSS)score before trombolysis,and incidence rate of atrial fibrillation of the secondary intracranial hemorrhage group were all significantly higher than those of the non-secondary intracranial hemorrhagegroup(all P<0.05),and the onset-to-needle time(ONT)of the secondary intracranial hemorrhage group was ignificantly shorter than that of the non-secondary intracranial hemorrhagegroup(P<0.05).The statistical results showed that the presence of atrial fibrillation history,high blood pressure before thrombolysis,especially elevated systolic blood pressure,were independent risk factors for bleeding transformation after intravenous alteplase thrombolysis in ACI patients(P=0.011,0.001,0.001,<0.001,0.003,0.036,<0.001).Conclusion The independent risk factors of intracranial hemorrhage in ACI patients after intravenous thrombolytic therapy with alteplase include the history of atrial fibrillation and hypertension dominated by systolic blood pressure before thrombolytic therapy.The above two factors had certain predictive value for bleeding transformation after thrombolysis.
作者
井艳丽
薛海龙
周林甫
田秀丽
JING Yanli;XUE Hailong;ZHOU Linfu;TIAN Xiuli(Department of Neurology,Baoji Second People's Hospital,Baoji Shaanxi 721000,China)
出处
《中国急救复苏与灾害医学杂志》
2022年第12期1602-1605,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
关键词
急性脑梗死
阿替普酶
静脉溶栓
颅内出血
影响因子
独立危险因素
Acute cerebral infarction
Alteplase
Intravenoue thrombolysis
Secondary intracranial hemorrhage
Impact factor
Risk factors
