急性缺血性脑卒中患者rt-PA静脉溶栓治疗期间出现滋扰性出血的临床观察

Clinical observation of intrusive bleeding during intravenous rt-PA thrombolysis in patients with acute ischemic stroke

目的分析急性缺血性脑卒中患者阿替普酶(rt-PA)静脉溶栓治疗期间出现滋扰性出血的临床特点。方法选取银川市中医医院2020年1月至2021年6月共40例急性缺血性脑卒中患者作为研究对象,收集患者个人情况、病史等相关资料,并按是否发生滋扰性出血情况分为出血组(n=11)与未出血组(n=29)。采用多因素Logistic回归分析探讨治疗期间滋扰性出血的影响因素。结果两组患者糖尿病史、高血压史、房颤史、应激性高血糖、神经功能缺损(NIHSS)评分、血尿酸水平、发病至溶栓治疗时间、前/后循环卒中比例比较,差异均有统计学意义(P<0.05)。NIHSS评分、血尿酸、发病至溶栓时间是急性缺血性脑卒中患者rt-PA静脉溶栓治疗期间滋扰性出血的影响因素(P<0.05)。未出血组预后情况优于出血组(χ^(2)=4.409,P=0.036)。结论导致急性缺血性脑卒中患者rt-PA静脉溶栓治疗期间出现滋扰性出血的影响因素较多,其中神经功能缺损、发病至溶栓治疗时间以及血尿酸是其影响因素,临床中应予以重视。

Objective To analyze the clinical characteristics of nuisance bleeding during intravenous thrombolytic therapy with alteplase(rt-PA)in patients with acute ischemic stroke.Methods A total of 40 patients with acute ischemic stroke in Yinchuan Hospital of Traditional Chinese Medicine from January 2020 to June 2021 were selected as the research objects.Collect the personal information,medical history and other relevant data of patients,and divided into the bleeding group(n=11)and the non-bleeding group(n=29)and the related factors of nuisance bleeding during treatment were analyzed.Multivariate Logistic regression analysis was used to explore the influencing factors of nuisance bleeding during treatment.Results The history of atrial fibrillation,history of diabetes,history of hypertension,stress hyperglycemia,NIHSS score,blood uric acid level,time from onset to thrombolytic therapy,and anterior/posterior circulation stroke were statistically significant in the bleeding group and the non-bleeding group(P<0.05).NIHSS score,blood uric acid level,and time from onset to thrombolysis are independent risk factors for nuisance bleeding during rt-PA intravenous thrombolysis in patients with acute ischemic stroke(P<0.05).The prognosis of the group without bleeding was better than that of the group with bleeding(χ^(2)=4.409,P=0.036).Conclusion There are many influencing factors that cause nuisance hemorrhage during rt-PA intravenous thrombolytic therapy in patients with acute ischemic stroke.Among them,neurological deficit,the time from onset to thrombolytic therapy and blood uric acid level are independent risk factors.China should pay attention to it.