缺血性脑卒中合并房颤患者行静脉溶栓治疗后出血转化的危险因素分析

Analysis of risk Factors for Hemorrhagic Transformation after Intravenous Thrombolytic Therapy in Patients with Ischemic Stroke Complicated with Atrial Fibrillation

目的分析缺血性脑卒中合并房颤患者行静脉溶栓治疗后出血转化(HT)的危险因素。方法选取2015年9月~2016年9月期间我院神经内科收治的急性缺血性脑卒中患者200例作为研究对象,按照心动图检查结果分为房颤组与非房颤组,各100例。所有患者均给静脉溶栓治疗。比较房颤组与非房颤组的出血转化情况;对性别、年龄、既往心血管疾病危险因素(吸烟、糖尿病、高血压、高脂血症)、既往卒中或短暂性脑缺血发作、溶栓时间窗、溶栓前及溶栓后24 h血压、启动溶栓后的收缩压变异系数和舒张压变异系数、溶栓前24 h血糖、溶栓前24 h血浆纤维蛋白原(Fbg)、溶栓前24 h血小板计数(BPC)、溶栓前24 h的NIHSS评分、溶栓前24 h颅脑CT变化等相关因素进行筛选;运用Logistic回归分析缺血性脑卒中合并房颤患者行静脉溶栓治疗后HT的危险因素。结果 (1)房颤组HT多于非房颤组(P<0.05),症状性颅内出血(SICH)多于非房颤组(P<0.05);(2)溶栓时间窗、溶栓前24 h收缩压、溶栓前24 h的NIHSS评分、溶栓前24 h颅脑CT变化、溶栓期间的收缩压变异系数和溶栓期间的舒张压变异系数等均对于HT与非HT有显著差异(P<0.05);(3)溶栓时间窗、溶栓前24 h收缩压、溶栓前24 h的NIHSS评分、溶栓前24 h颅脑CT变化、溶栓期间的收缩压变异系数和溶栓期间的舒张压变异系数是房颤组静脉溶栓后HT危险因素。结论缺血性脑卒中合并房颤患者选择静脉溶栓治疗的时候,应当尽量回避可能导致HT的高危因素。

Objective To analyze the risk factors of hemorrhagic transformation （HT）in patients with ischemic stroke and atrial fibrillation （AF） after intravenous thrombolytic therapy. Methods A total of 200 patients with acute ischemic stroke were enrolled in Department of Neurology of our hospital from September 2015 to September 2016. According to the results of EKG, the patients were divided into AF group and non-AF group. All patients were given intravenous thrombolytic therapy. The hemorrhagic transformation was compared between AF group and non-AF group; the relevant factors were filtered such as Gender, age, previous cardiovascular risk factors （ smoking, diabetes, hypertension, hyperlipidemia ）, previous stroke or transient ischemic attack, onset to treatment time, blood pressure 24 h before and after thrombolysis, the coefficient of variation of systolic blood pressure and the coefficient of variation of diastolic blood pressure after thrombolysis, blood glucose 24 h before thrombolysis, plasma fibrinogen 24 h before thrombolysis, platelet count 24 h before thrombolysis, NIHSS score 24 h before thrombolysis, brain CT changes 24 h before thrombolysis; Logistic regression was used to analyze the risk factors of hemorrhagic stroke after intravenous thrombolytic therapy in patients with ischemic stroke compli higher than that of non- AF group （ P 〈 0. 05 ）, higher than that of non- AF group （ P 〈 0.05 ） before thrombolysis, NIHSS score 24 hours cated with atrial fibrillation. Results ①HT in AF group was symptomatic intracranial hemorrhage （SICH）in AF group was ;②Onset to treatment time, systolic blood pressure 24 hours before thrombolysis, brain CT changes 24 hours before thrombolysis, systolic blood pressure coefficient during thrombolysis and diastolic blood pressure coefficient during thrombolysis were significant difference between HT and non- HT （ p 〈 0. 05 ）, which was statistically significant. ③Onset to treatment time, systolic blood pressure 24 hours before thrombolysis, NIHSS score before thrombolysis, CT changes in 24 hours before thrombolysis, systolic blood pressure coefficient during thrombolysis and diastolic blood pressure during thrombolysis HT risk factors after intravenous thrombolysis. Conclusion Patients with ischemic stroke combined with AF choose intravenous thrombolytic therapy, should try to avoid the risk factors that may lead to HT