急性缺血性脑卒中静脉溶栓后出血性转化危险的影响因素分析
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摘要
目的探讨急性缺血性脑卒中静脉溶栓后出血性转化(HT)危险的影响因素。方法纳入2017年10月至2018年10月在本院行静脉溶栓治疗的85例急性缺血性脑卒中患者为研究对象,所有患者于治疗后1周内行头颅CT检查,根据头颅有无出血性转化分为HT组与无HT组,对静脉溶栓治疗后出血性转化的危险因素进行单因素和多因素Logistic回归分析。结果经单因素分析,两组患者性别、年龄、高血压史、糖尿病史、吸烟史、大面积脑梗死、溶栓时间窗、溶栓前舒张压、溶栓前收缩压、溶栓前血糖、溶栓前纤维蛋白原及溶栓前血小板计数比较差异无统计学意义;HT组心房纤颤、溶栓前头颅CT有早期缺血改变发生率显著高于无HT组(P<0.05),且溶栓前NIHSS评分明显高于无HT组(P<0.05);经Logistic多因素回归分析,心房纤颤、NIHSS评分及溶栓前头颅CT有早期缺血改变与静脉溶栓后HT发生的独立相关。结论心房纤颤、NIHSS评分及溶栓前头颅CT有早期缺血改变为溶栓后HT的独立危险因素,影响着溶栓治疗后HT患者的预后。
Objective To investigate the influencing factors of hemorrhagic transformation(HT) risk after intravenous thrombolysis in acute ischemic stroke. Methods 85 patients with acute ischemic stroke who underwent intravenous thrombolysis in our hospital from October 2017 to October 2018 were enrolled. All patients underwent CT scan 1 week after treatment, according to whether there was bleeding in the head. Sexual transformation was divided into HT group and no HT group. Univariate and multivariate logistic regression analysis were performed on the risk factors of hemorrhagic transformation after intravenous thrombolytic therapy. Results Single factor analysis. Gender, age, history of hypertension, history of diabetes, smoking history, large area cerebral infarction, time window of thrombolysis, diastolic blood pressure before thrombolysis, systolic blood pressure before thrombolysis, blood glucose before thrombolysis, dissolution There was no significant difference in pre-plug fibrinogen and platelet count before thrombolysis. The incidence of early ischemic changes in HT group with atrial fibrillation and CT before thrombolysis was significantly higher than that in non-HT group(P<0.05), and the NIHSS score before thrombolysis was significantly higher than that without HT group(P<0.05). Logistic multivariate regression analysis showed atrial fibrillation, NIHSS score and early ischemic changes after thrombolysis. Independent correlation of HT occurrence. Conclusions Atrial fibrillation, NIHSS score and early ischemic changes in thrombus before thrombolysis are independent risk factors for HT after thrombolysis, which affects the prognosis of patients with HT after thrombolytic therapy.
Objective To investigate the influencing factors of hemorrhagic transformation(HT) risk after intravenous thrombolysis in acute ischemic stroke. Methods 85 patients with acute ischemic stroke who underwent intravenous thrombolysis in our hospital from October 2017 to October 2018 were enrolled. All patients underwent CT scan 1 week after treatment, according to whether there was bleeding in the head. Sexual transformation was divided into HT group and no HT group. Univariate and multivariate logistic regression analysis were performed on the risk factors of hemorrhagic transformation after intravenous thrombolytic therapy. Results Single factor analysis. Gender, age, history of hypertension, history of diabetes, smoking history, large area cerebral infarction, time window of thrombolysis, diastolic blood pressure before thrombolysis, systolic blood pressure before thrombolysis, blood glucose before thrombolysis, dissolution There was no significant difference in pre-plug fibrinogen and platelet count before thrombolysis. The incidence of early ischemic changes in HT group with atrial fibrillation and CT before thrombolysis was significantly higher than that in non-HT group(P<0.05), and the NIHSS score before thrombolysis was significantly higher than that without HT group(P<0.05). Logistic multivariate regression analysis showed atrial fibrillation, NIHSS score and early ischemic changes after thrombolysis. Independent correlation of HT occurrence. Conclusions Atrial fibrillation, NIHSS score and early ischemic changes in thrombus before thrombolysis are independent risk factors for HT after thrombolysis, which affects the prognosis of patients with HT after thrombolytic therapy.
引文
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[8]张元媛,周宏智,吕美云,等.急性缺血性卒中机械取栓后出血性转化和临床转归的影响因素[J].国际脑血管病杂志,2016,24(10):882-886.
[9]李丽.脑梗死静脉溶栓治疗后出血性转化及其预后的危险因素分析[J].中西医结合心脑血管病杂志,2015,13(6):837-839.
[2]冼文川,朱育昌,张惠婷,等.缺血性脑卒中患者静脉溶栓后出血性转化[J].中国老年学,2015,35(1):110-111.
[3]中华医学会神经病学分会脑血管病学组急性缺血性卒中诊治指南撰写组.中国急性缺血性卒中诊治指南(2010)[J].中华神经科杂志,2010,43(2):146-153.
[4]陆霞,张万里,韩钊,等.抗血小板药物服用史与急性缺血性卒中静脉溶栓后颅内出血转化的相关性[J].中华神经科杂志,2015,48(5):377-381.
[5]王娟娟,马利.超高龄缺血性卒中患者合并出血性转化的危险因素分析[J].神经损伤与功能重建,2017,12(6):501-503.
[6] Lei C, Wu B, Liu M, et al. Totaled health risks in vascular events seore predicts clinical outcomes in patients with cardioembolic and other subtypes of isehemic stroke[J]. Stroke, 2014,45(5):1689-1694.
[7]陈明丽,郭梦,李长清.急性缺血性卒中患者的出血性转化[J].国际脑血管病杂志,2015,23(6):459-463.
[8]张元媛,周宏智,吕美云,等.急性缺血性卒中机械取栓后出血性转化和临床转归的影响因素[J].国际脑血管病杂志,2016,24(10):882-886.
[9]李丽.脑梗死静脉溶栓治疗后出血性转化及其预后的危险因素分析[J].中西医结合心脑血管病杂志,2015,13(6):837-839.