多模式MRI指导的急性期脑梗死rt-PA静脉溶栓后的出血转化及相关因素分析

Risk of intracerebral hemorrhage following Multi-modality MRI-based intravenous thrombolytic therapy with rtPA for acute cerebral infarction

目的探讨多模式MRI指导的颈内动脉系统急性期脑梗死患者接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后发生出血转化的相关危险因素。方法对103例急性期颈内动脉系统脑梗死患者在标准时间窗(4.5h内)进行rt-PA静脉溶栓治疗。观察患者性别、年龄、吸烟、饮酒、高血压病、糖尿病、房颤、血脂、NIHSS评分及ASPECT评分与溶栓后出血的相关性。结果溶栓后发生出血转化的患者共17例,其中症状性脑出血患者有5例,占所有溶栓患者的4.85%、所有出血患者的29.41%。溶栓后脑出血与房颤、NIHSS评分及ASPECT评分均有相关性(P<0.05)。结论有房颤、NIHSS评分高及ASPECT评分低者行rt-PA静脉溶栓容易发生出血转化。

Objective To identify risk factors for intracerebral hemorrhage following Multi-modality MRI-based intravenous thrombolytic therapy with rt-PA for acute cerebral infarction in carotid territory.Methods 103 patients with acute carotid territory stroke received intravenous rt-PA within 4.5 hours of symptom onset.The factors including gender,age,smoking,alcohol,hypertension,diabetes mellitus,atrial fibrillation,blood lipids as well as NIHSS and ASPECT scores were collected to correlated with risks of intracerebral hemorrhage.Results After intravenous rt-PA administration,17 patients combined with intracerebral hemorrhage,5 patients developed symptomatic intracerebral hemorrhage account for 4.85% of overall rt-PA treated patients and 29.41% of patients with intracerebral hemorrhage respectively.Risk of recurrence of intracerebral hemorrhage was closely correlated with atrial fibrillation and scores of NHISS and ASPECT.Conclusion Overall,rt-PA treated patients with atrial fibrillation,high scores of NHISS and low scores of ASPECT had an increased risk of intracerebral hemorrhage.