急性脑梗死静脉溶栓患者出血转化及预后的危险因素研究

目的探讨急性缺血性脑卒中(acute ischemic stroke,AIS)静脉溶栓后出血转化及预后的危险因素。方法选择2017年6月-2019年6月211例进行静脉溶栓治疗的AIS患者为研究对象,其中出血转化(hemorrhagic tromsformation,HT)的34例患者记为HT组,未出血转化的177例患者记为未HT组,出血转化率16.11%,分析静脉溶栓过程中强化降压与AIS静脉溶栓患者出血转化及预后的关系。结果单因素分析提示性别、年龄、从起病至阿替普酶(reombinant tissue plasminogen activator,rt-PA)溶栓治疗的时间间隔(onset to start of treatment,OTT)、入院血糖、基线美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、2型糖尿病、心房颤动、静脉溶栓过程中强化降压差异有统计学意义(P<0.05或P<0.01),为静脉溶栓后HT的相关危险因素;二元Logistic分析表明基线NIHSS评分>17.5分为AIS患者静脉溶栓出血转化的独立危险因素(OR=1.639,P=0.013)。而心房颤动(OR=9.129,P<0.01)为静脉溶栓患者预后的独立危险因素。结论基线NIHSS评分>17.5分为AIS患者静脉溶栓后HT的独立危险因素,而静脉溶栓过程中强化降压为HT的相关危险因素;心房颤动为静脉溶栓患者预后的独立危险因素。

Risk factors of hemorrhagic transformation and prognosis in patients with acute cerebral infarction and intravenous thrombolysis

Objective To explore the risk factors of hemorrhagic transformation and prognosis of acute ischemic stroke(AIS)after intravenous thrombolysis.Methods From June 2017 to June 2019,211 patients with AIS undergoing intravenous thrombolysis were selected as the research object.Among them,34 patients with hemorrhagic tromsformation(HT)were recorded as HT group,and 177 patients without hemorrhagic transformation The patient was recorded as a non-HT group,with a bleeding conversion rate of 16.11%.The relationship between intensive blood pressure reduction and bleeding conversion and prognosis in patients with AIS intravenous thrombolysis was analyzed during intravenous thrombolysis.Results Univariate analysis revealed gender,age,time interval between onset to start of treatment(OTT),blood glucose at admission,baseline blood pressure,and baseline from the onset to start of treatment(reombinant tissue plasminogen activator,rt-PA)The National Institute of Health stroke scale(NIHSS)score,type 2 diabetes,atrial fibrillation,and venous thrombolysis have statistically significant differences(P<0.05 or P<0.01),which is a vein Risk factors related to HT after thrombolysis;binary logistic analysis showed that the baseline NIHSS score of 17.5 was divided into independent risk factors for the transformation of venous thrombolysis hemorrhage in AIS patients(OR=1.639,P=0.013).Atrial fibrillation(OR=9.129,P<0.01)is an independent risk factor for the prognosis of patients with intravenous thrombolysis.Conclusion The baseline NIHSS score of 17.5 is divided into independent risk factors for HT after intravenous thrombolysis in AIS patients,and intensive blood pressure reduction during intravenous thrombolysis is a related risk factor for HT;atrial fibrillation is an independent risk factor for the prognosis of patients with intravenous thrombolysis.