摘要
目的探讨老年急性缺血性脑卒中(CIS)患者溶栓后出血转化(HT)的影响因素。方法抽取2019年11月至2021年12月郑州人民医院收治的老年CIS患者207例,均接受溶栓治疗,根据溶栓后是否发生HT分为HT组(发生HT,42例)与对照组(未发生HT,165例)。采用单因素分析及多因素Logistic回归分析CIS患者的临床资料,探讨溶栓后发生HT的影响因素。结果单因素分析结果显示,HT组≥80岁、有心房颤动病史、美国国立卫生院神经功能缺损量表(NIHSS)评分≥20分、大面积脑梗死、CT显示脑白质疏松者比例均高于对照组(P均<0.05),HT组行溶栓24 h内抗血小板治疗者比例(76.19%,32/42)低于对照组(89.70%,148/165),P<0.05。两组其余因素患者比例比较差异未见统计学意义(P>0.05)。多因素Logistic回归分析结果显示,有心房颤动病史(OR=1.81,P=0.004)、NIHSS评分≥20分(OR=3.11,P=0.001)、大面积脑梗死(OR=2.56,P=0.022)、CT显示脑白质疏松(OR=1.40,P=0.006)是老年CIS患者溶栓后发生HT的危险因素,溶栓24 h内抗血小板治疗(OR=0.39,P=0.012)是保护性因素。结论老年CIS患者溶栓后发生HT的危险因素包括心房颤动、NIHSS评分≥20分、大面积脑梗死、CT显示脑白质疏松,对于此类患者临床应加以重视,并把握抗血小板治疗的时机,以降低出血风险。
Objective To investigate the influencing factors of hemorrhagic transformation(HT)after thrombolysis in elderly patients with acute cerebral ischemic stroke(CIS).Methods A total of 207 elderly patients with CIS who were admitted to Zhengzhou People’s Hospital from November 2019 to December 2021 were selected,and all selected patients received thrombolysis,and they were divided into HT group(with HT,42 cases)and control group(without HT,165 cases)according to occurrence of HT after thrombolysis.Univariate analysis and multivariate Logistic regression were used to analyze the clinical data of CIS patients,and the influencing factors of HT after thrombolysis were discussed.Results Results of univariate analysis showed that the proportion of patients aged≥80 years,with a history of atrial fibrillation,National Institutes of Health Stroke Scale(NIHSS)score≥20,large-area cerebral infarction,and leukoaraiosis on CT of atrial fibrillation in the HT group were higher than those in the control group(all P<0.05),the proportion of patients receiving antiplatelet therapy within 24 hours after thrombolysis in the HT group(76.19%,32/42)was lower than that in the control group(89.70%,148/165),P<0.05.There was no significant difference in the proportion of patients with other factors between the two groups(P>0.05).Results of multivariate Logistic regression analysis showed that history of atrial fibrillation(OR=1.81,P=0.004),NIHSS score≥20(OR=3.11,P=0.001),massive cerebral infarction(OR=2.56,P=0.022),and leukoaraiosis on CT of atrial fibrillation(OR=1.40,P=0.006)were risk factors for HT after thrombolysis in elderly CIS patients,while antiplatelet therapy within 24 hours after thrombolysis(OR=0.39,P=0.012)was a protective factor.Conclusions The risk factors for HT after thrombolysis in elderly CIS patients include atrial fibrillation,NIHSS score≥20,large-area cerebral infarction,and leukoaraiosis on CT.Clinicians should pay more attention to such patients,and seize the timing of antiplatelet therapy to reduce the risk o
作者
李艳丽
周俊超
刘晓君
Li Yanli;Zhou Junchao;Liu Xiaojun(Department of Neurology,Southern District Branch,Zhengzhou People’s Hospital,Zhengzhou 450000,China)
出处
《中国实用医刊》
2022年第9期13-17,共5页
Chinese Journal of Practical Medicine
基金
2020年度河南省医学科技攻关计划联合共建项目(LHGJ20200693)。
关键词
缺血性脑卒中
溶栓
出血转化
影响因素
Stroke,ischemia
Thrombolysis
Hemorrhagic transformation
Influencing factor
