高龄脑梗死患者经静脉溶栓后早期颅内出血的相关因素分析

Analysis of related factors of early intracranial hemorrhage after intravenous rt-PA thrombolysis in advance-aged patients with cerebral infarction

目的研究高龄脑梗死患者接受重组组织型纤溶酶原激活物(rt-PA)静脉溶栓后早期颅内出血(ICH)的相关因素。方法连续收集2006年7月—2011年10月上海市第一人民医院分院神经科于发病4.5 h内给予rt-PA静脉溶栓治疗的急性脑梗死患者,共175例。根据患者年龄分为年龄<80岁组(121例)和年龄≥80岁组(54例),对所有患者的临床资料进行回顾性分析。统计溶栓后24 h内颅内出血(ICH)和症状性颅内出血(SICH)的例数。采用改良Rankin(mRS)评分对存活的ICH患者进行随访。结果①共31例(17.7%)患者于溶栓后24 h发生ICH,年龄<80岁组和年龄≥80岁组的ICH发生率分别为15.7%和22.2%,SICH发生率分别为5.8%和14.8%,两组患者ICH和SICH发生率的比较,差异无统计学意义,P>0.05。②在脑白质疏松(LA)患者中,年龄<80岁组的ICH发生率(16.7%)低于年龄≥80岁组(36.6%),差异有统计学意义(χ2=4.643,P=0.031);其余可能的危险因素,年龄<80m岁组与≥80岁组的ICH发生率比较,差异无统计学意义。③共23例ICH患者好转出院。出院后90 d随访显示,年龄<80岁组患者的基本痊愈和轻中度残疾的比例高于年龄≥80岁组,重度残疾的比例低于年龄≥80岁组,但差异无统计学意义。结论 LA可能与高龄患者溶栓后早期ICH具有相关性。

Objective To study the related factors of early intracranial hemorrhage （ICH） after receiving in-travenous recombinant tissue-type plasminogen activator （rt-PA） thrombolysis in advance-aged patients with cer-ebral infarction. Methods A total of 175 consecutives patients with acute cerebral infarction who received in-travenous rt-PA thrombolysis within 4. 5 hours after onset in the Department of Neurology, the Branch of Shang-hai First People＇s Hospital from July 2006 to October 2011 were collected. The patients were divided into a 〈80-year old group （n=121） and a ≥ 80-year old group （n=54） according to the age of the patients. All the patients＇medical history, clinical and laboratory as well as imaging studies （CT, MRI） and other information were studied retrospectively. The numbers of patients with ICH and symptomatic ICH （SICH） within 24 hours after thrombolysis were calculated. The modified Rankin scale （mRS） scores were used to follow up the survival patients with ICH. Results ①Thirty-one patients （17.7%） had ICH within 24 hours after thrombolysis. The incidences of the 〈 80-year old group and the ≥ 80-year old group were 15.7% and 22.2% respectively. The incidences of SICH were 5.8% and 14.8% respectively. There were no significant differences in the incidences of ICH and SICH between the 2 groups （P 〉 0.05）. ②In patients with leukoaraiosis （LA）, the incidence of ICH （16.7%） in the 〈80-year old group was lower than that in the I〉80-year old group （36.6%）. There was significant difference （ X^2 = 4. 643, P = 0. 031 ）. ③A total of 23 patients with ICH improved and dis-charged. The proportions of nearly cure and mild to moderate disabilities in the 〈 80-year old group were higher than those in the ≥80-year old group, and the proportion of severe disability was lower than that in the ≥80-year old group, however, there was no significant difference. Condusion Patients with lenkoaraiosis may be associated with early intraeranial hemorrhage after thrombolysis in the advance-aged patients.