急性缺血性脑卒中患者介入取栓后出血转化的相关危险因素

目的 探讨急性缺血性脑卒中(AIS)患者介入取栓后出血转化(HT)的危险因素。方法 选择本院2017年1月-2020年1月收治的AIS患者226例,所有患者均接受介入取栓治疗,比较2组年龄、性别、既往史、吸烟史、饮酒史、溶栓治疗情况、闭塞血管等临床资料,多因素Logistic 回归分析AIS患者取栓术后HT发生的危险因素。结果 226例AIS患者均成功完成介入取栓手术,其中发生HT 44例(HT组),未发生HT182例(非HT组),HT组房颤史占比、闭塞血管为前循环占比、取栓次数、术中替罗非班应用率、术后收缩压均高于非HT组(P<0.05或P<0.01),术前NIHSS评分低于非HT组(P<0.01)。以是否发生HT为因变量,以上述差异有统计学意义的指标为自变量,多因素Logistic 回归分析显示房颤史、闭塞血管位于前循环、取栓次数和术后收缩压为AIS患者介入取栓后HT发生的独立危险因素。结论 房颤史、闭塞血管位于前循环、取栓次数增加和术后收缩压升高是AIS患者取栓术后HT发生的危险因素,对于具有上述因素的AIS患者要综合评估介入取栓的利弊,实施介入取栓后要密切监护病情变化。

The risk factors of hemorrhage transformation in patients with acute ischemic stroke after thrombectomy

ObjectiveTo investigate the risk factors of haemorrhagic transformation(HT)in patients with acute ischemic stroke(AIS).Methods 226 patients with AIS admitted to our hospital from January, 2017 to January, 2020 were selected. All patients received interventional thrombectomy. The clinical data of age, gender, past history, smoking history, drinking history, thrombolytic therapy and occlusion of blood vessels were compared between the two groups. The risk factors of HT in AIS patients after thrombectomy were analyzed by multivariate logistic regression.Results 226 AIS patients were successfully treated by the interventional thrombectomy, HT occurred in 44 cases of HT group and 82 cases of non HT group did not occur HT. The history of atrial fibrillation(AF), the proportion of anterior circulation of occluded vessels, the times of thrombectomy, the application rate of tirofiban during operation and the systolic blood pressure after operation of the HT group were all higher than those of the non HT group(P<0.05 or P<0.01). The NIHSS score before operation of the HT group was lower than that of the non HT group(P<0.01). With the occurrence of HT as the dependent variable and the indicators with statistical significance as the independent variable, the multivariate logistic regression analysis showed that the history of AF, the location of occluded vessels in the anterior circulation, the number of thrombus taking and postoperative systolic blood pressure were independent risk factors for the occurrence of HT in AIS patients.Conclusion The history of AF, the location of occluded vessels in anterior circulation, the increase of thrombectomy times and the increase of systolic blood pressure after operation were the risk factors of HT after thrombectomy in AIS patients.