尿激酶动脉内溶栓治疗急性脑梗死致症状性脑出血多因素分析

Analysis of multi-factors affecting symptomatic intracranial hemorrhage in intraarterial thrombolysis with urokinase for acute ischemic stroke

目的探讨尿激酶局部动脉内溶栓治疗急性缺血性脑梗死并发症状性脑出血的原因及防治措施。方法我院从1999年2月至2004年6月共有217例急性缺血性脑梗死进行尿激酶局部动脉内溶栓治疗,我们对并发症状性脑出血的密切相关因素利用SPSS11.5软件进行多因素逻辑回归分析,评价这些因素的风险。结果症状性颅内出血共有8例(3.7%),溶栓前高水平的收缩压[比数比(OR),1.096;比数比的95%可信区间(CI),1.006～1.194]和尿激酶治疗(OR,1.068;95%CI,1.053～1.247)是预测症状性脑出血的因素。在溶栓患者,随收缩压升高,症状性脑出血的风险随之增高,其他年龄、溶栓开始时间、溶栓时脑卒中评分(NIHSS)、糖尿病、侧支循环因素均不能预测症状性脑出血发生与否。结论尿激酶局部动脉内溶栓治疗急性缺血性脑梗死并发症状性脑出血,与溶栓前高水平的收缩压和尿激酶治疗有关。

Objective To explore the causes and preventive measures of symptomatic intracranial hemorrhage in 217 patients with acute cerebral ischemic stroke treated with local intra-arterial urokinase. Methods From February1999 to June 2004, 217 patients were treated for acute ischemic stroke with local intra-arterial urokinase in our hospital. Factors associated with symptomatic intracranial hemorrhage of intra-arterial thrombolysis were analyzed by Stepwise logistic regression to identify some factors relating the prediction symptomatic intracranial hemorrhage. Results Symptomatic intracranial hemorrhage occurred in 8 cases （3.7%）. Predictors of the symptomatic intracranial hemorrhage were the elevated systolic blood pressure before therapy （odds ratio, 1.096; 95% CI, 1.006 to 1.194） and urokinase （UK） treatment （odds ratio , 1.068; 95% CL, 1.053 to 1.247）. Risk of secondary symptomatic intracranial hemorrhage was increased with elevated systolic blood pressure. Other factors like age, initial treating time, NIHSS, diabetes and collateral circulation did not predict the symptomatic intracranial hemorrhage respectively. Conclusions Predictors of symptomatic intracranial hemorrhage after local intra-arterial infusion of urokinase for acute ischemic stroke were the elevated systolic blood pressure before therapy and urokinase （UK） treatment.