阿替普酶静脉溶栓治疗急性脑梗死后发生脑出血转化的影响因素分析

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中文摘要：目的研究阿替普酶静脉溶栓治疗急性脑梗死后发生脑出血转化的影响因素.方法回顾性分析 180 例通过阿替普酶静脉溶栓治疗的急性脑梗死患者的临床资料,包括性别、年龄、体质量指数(BMI)、吸烟史、心房颤动(房颤)史及合并高血压、合并糖尿病、合并高血脂、溶栓时间窗≥3 h、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分＞8 分、实施抗血小板治疗、溶栓 24 h后神经症状改善、脑疝情况,分析脑出血转化发生情况,并采用单因素及多因素分析导致患者发生脑出血转化的独立危险因素.结果 180 例阿替普酶静脉溶栓治疗的急性脑梗死患者中出现脑出血转化 17 例、占9.44%,无脑出血转化 163 例、占 90.56%.脑出血转化患者年龄≥65 岁占比 88.24%、BMI≥28 kg/m2占比 76.47%、有吸烟史占比 94.12%、有房颤史占比 35.29%、合并高血压占比 82.35%、合并糖尿病占比 58.82%、合并高血脂占比 88.24%、溶栓时间窗≥3 h占比 88.24%、溶栓前NIHSS评分>8 分占比 58.82%、脑疝占比 94.12%均高于无脑出血转化患者的 55.83%、6.13%、55.21%、11.66%、14.11%、12.88%、12.27%、12.27%、26.99%、3.07%,实施抗血小板治疗占比 11.76%、溶栓 24 h后神经症状改善占比 11.76%均低于无脑出血转化患者的 86.50%、84.66%,差异有统计学意义(P<0.05).经Logistic多因素回归分析,合并高血压、合并高血脂、溶栓时间窗≥3 h、溶栓前NIHSS评分>8 分、溶栓 24 h后神经症状没有改善、脑疝是阿替普酶溶栓治疗急性脑梗死后发生脑出血转化的独立危险因素(P<0.05).结论阿替普酶静脉溶栓治疗急性脑梗死后出现脑出血转化的影响因素是多方面的,要针各类风险做好强化观察和处理,尽可能避免患者出现脑出血转化而影响预后.

外文标题：Analysis of influencing factors of hemorrhage transformation after intravenous alteplase thrombolysis in patients with acute cerebral infarction

外文摘要：Objective To study the influencing factors of hemorrhage transformation after intravenous alteplase thrombolysis in patients with acute cerebral infarction.Methods The clinical data of 180 patients with acute cerebral infarction treated by intravenous alteplase thrombolysis were analyzed retrospectively,including gender,age,body mass index(BMI),history of smoking,history of atrial fibrillation,comorbid hypertension,comorbid diabetes mellitus,comorbid hyperlipidemia,time window for thrombolysis≥3 h,pre-thrombolysis National Institutes of Health Stroke Scale(NIHSS)score>8 points,implementation of antiplatelet therapy,improvement of neurological symptoms after 24 h of thrombolysis,and cerebral herniation.The incidence of hemorrhage transformation was analyzed,and the independent risk factors leading to hemorrhage transformation were analyzed by univariate and multivariate analysis.Results Among 180 patients with acute cerebral infarction treated with intravenous alteplase thrombolysis,there were 17 cases had hemorrhage transformation,accounting for 9.44%,and 163 cases had no hemorrhage transformation,accounting for 90.56%.88.24%of patients with hemorrhage transformation were≥65 years old,76.47%had BMI≥28 kg/m2,94.12%had history of smoking,35.29%had history of atrial fibrillation,82.35%had hypertension,58.82%had diabetes mellitus,88.24%had hyperlipemia,88.24%had time window for thrombolysis≥3 h,58.82%had pre-thrombolysis NIHSS score>8 points,and 94.12%had cerebral hernia,which were higher than 55.83%,6.13%,55.21%,11.66%,14.11%,12.88%,12.27%,12.27%,26.99%,and 3.07%of patients without hemorrhage transformation;the implementation of antiplatelet therapy accounted for 11.76%,and the improvement of neurological symptoms after 24 h of thrombolysis accounted for 11.76%,which were lower than 86.50%and 84.66%of patients without hemorrhage transformation;the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that comorbid hypertension,comorbid hyperlipidemia,time window for thrombolysis≥3 h,pre-thrombolysis NIHSS score>8 points,no improvement of neurological symptoms after 24 h of thrombolysis,and cerebral hernia were independent risk factors for hemorrhage transformation after intravenous alteplase thrombolysis in patients with acute cerebral infarction(P<0.05).Conclusion The influencing factors of hemorrhage transformation after intravenous alteplase thrombolysis for acute cerebral infarction are multifaceted.It is necessary to strengthen the observation and treatment of various risks for patients,so as to avoid as far as possible the emergence of hemorrhage transformation in patients and affect the prognosis.

外文关键词：

AlteplaseIntravenous thrombolysisAcute cerebral infarctionHemorrhage transformationIndependent risk factor

作者：

韩伟

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作者单位：

024000 内蒙古赤峰市医院神经内科

关键词：

阿替普酶静脉溶栓急性脑梗死脑出血转化独立危险因素

出版年：

2024

DOI：