阿替普酶静脉溶栓治疗急性缺血性脑卒中出血并发症发生时间的观察

The time of hemorrhage caused by intravenous thrombolytic therapy with recombinant tissue plasminogen activator in patients with acute cerebral infarction

目的探讨急性缺血性脑卒中患者进行阿替普酶(rt-PA)静脉溶栓治疗所致出血并发症的发生时间。方法对发病4.5h内的40例急性缺血性脑卒中患者行rt-PA静脉溶栓治疗,观察溶栓治疗开始至48h内各部位出血并发症发生时间。结果开始静脉溶栓至溶栓结束后48h内,无出血症状患者23例,出现不同部位出血患者17例,其中皮下淤血16例,牙龈出血7例,消化道出血5例,鼻出血、血尿各2例。出血发生时间为5min^26h。结论静脉溶栓过程中,护士应密切监测患者血压波动、意识、肌力等神经科体征变化及黏膜出血特征,及早发现出血并发症,早识别以便及早处理。

Objective To investigate the time of hemorrhage caused by intravenous thrombolytic therapy with re- combinant tissue plasminogen aetivator（rt-PA） in patients with acute cerebral infarction（ACI）. Methods Forty ACI patients were treated with rt-PA intravenous thrombolytic therapy within 4.5 hours. The time of hemorrhage in each part was observed within 48 hours after thrombolytic therapy. Results Seventeen patients suffered from hemor- rhage,including 16 cases of subcutaneous congestion,7 cases of gingival bleeding,5 cases of gastrointestinal bleed- ing,2 cases of nose bleeding and 2 cases of hematuria. The time of hemorrhage ranged from 5min to 26h after thrombolytic therapy. Conclusion Nurses should closely monitor patients＇ blood pressure fluctuations,consciousness, muscle strength and other neurological signs and mueosal hemorrhage,early detect and treat hemorrhage during in- travenous thrombolytic therapy.