摘要
目的探讨影响急性脑梗死(ACI)患者静脉重组组织型纤溶酶原激活剂(rt-PA)溶栓后出血转化的危险因素。方法回顾性分析2017年1月~2018年12月我院治疗的60例ACI患者临床资料,采用多因素Logistic回归分析ACI患者rt-PA溶栓后出血转化的危险因素。结果患者根据静脉rt-PA溶栓治疗后是否发生出血转化分为HT组和NHT组,其中HT组为21例发生出血转化患者,NHT组为39例未发生出血转化患者,出血转化发生率为35.00%,HT组合并房颤占比、血糖(Glu)、血钠(Na)、治疗前美国国立卫生研究院卒中量表(NIHSS)评分均高于NHT组,差异有统计学意义(P<0.05);Logistic回归分析结果提示,合并房颤、Glu、Na,NIHSS评分均属于rt-PA溶栓后出血转化的危险因素[合并房颤(β=2.368,SE=1.18,OR=10.676,P=0.045,95%CI=1.057~107.856);Glu(β=2.678,SE=1.071,OR=14.556,P=0.013,95%CI=1.787~118.534);Na (β=2.284,SE=1.147,OR=13.518,P=0.024,95%CI=1.427~128.011);治疗前NIHSS (β=2.604,SE=1.18,OR=10.676,P=0.045,95%CI=1.057~107.856)]。结论 ACI患者静脉rtPA溶栓后出血转化与患者治疗前Glu、Na水平过高、有房颤、神经功能严重缺失程度高等因素密切相关,治疗时应该对此类患者谨慎给药,减少出血转化发生率。
Objective To investigate the risk factors influencing hemorrhagic transformation(HT) after intravenous recombinant tissue plasminogen activator rt-PA thrombolysis in patients with acute cerebral infarction(ACI). Methods The clinical data of 60 ACI patients in our hospital from January 2017 to December 2018 were retrospectively analyzed. Multivariate Logistic regression analysis was performed to analyze risk factors of HT after rt-PA thrombolysis in ACI patients. Results According to presence or absence of HT after intravenous rt-PA thrombolysis, 60 patients were divided into HT group and NHT group. In HT group, there were 21 cases with HT. In NHT group, there were 39 cases without HT. The incidence of HT was 35.00%. The atrial fibrillation ratio, Glu level, Na level and national institute of health stroke scale(NIHSS) score in HT group were higher than those in NHT group(P<0.05). Logistic regression analysis results indicated atrial fibrillation, Glu, Na,that NIHSS before treatment was a risk factor for hemorrhage transformation after thrombolysis by rt-PA([β=2.368, SE=1.18, OR=10.676, P=0.045, 95%CI=1.057-107.856]. Glu [β=2.678,SE=1.071, OR=14.556, P=0.013, 95%CI=1.787-118.534];Na [β=2.284, SE=1.147, OR=13.518, P=0.024, 95%CI=1.4271-128.011];NIHSS [β=2.604, SE=1.18, OR=10.676, P=0.045, 95%CI=1.057-107.856]). Conclusion Conversion of hemorrhage after intravenous rt-PA thrombolysis in patients with ACI was closely related with before treatment, Glu and Na levels high, atrial fibrillation and severe neurological deficits. It should be treated with caution, reduce the incidence of haemorrhagic transformation.
作者
赵超
ZHAO Chao(Department of Neurology,Shangrao Municipal Hospital,Jiangxi Province,Shangrao334000,China)
出处
《中国当代医药》
2019年第35期103-105,共3页
China Modern Medicine
关键词
急性脑梗死
静脉重组组织型纤溶酶原激活剂溶栓
出血转化
溶栓治疗
Acute cerebral infarction
Intravenous recombinant tissue plasminogen activator thrombolysis
Hemorrhagic transformation
Fibrinolytic therapy
