急性脑梗死患者阿替普酶静脉溶栓的疗效及出血性转化影响因素分析

The efficacy and risk factors of hemorrhagic transformation of intravenous thrombolysis with recombinant tissue plasminogen activator( rt-PA) in acute cerebral infarction patients

目的研究阿替普酶(rt-PA)静脉溶栓治疗急性脑梗死(ACI)的疗效,并分析静脉溶栓后出血性转化(HT)的影响因素。方法选择发病在6h以内的ACI患者174例,根据治疗方法的不同分为静脉溶栓和常规治疗两组,比较两组治疗前和治疗后24h、14d美国国立卫生研究院卒中量表(NIHSS)评分,90d后改良Rankin量表(m RS)评分的变化,并记录不良反应;比较静脉溶栓组有无出血并发症患者之间的影响因素,多因素回归分析确定溶栓后HT的独立危险因素。结果 1静脉溶栓组溶栓后24h、14d NIHSS评分较溶栓前明显降低(P<0.05),常规治疗组治疗后24 h、14 d NHISS评分与溶栓前比较,差异无统计学意义(P>0.05),治疗后同一时间点比较静脉溶栓组的NHISS评分均低于常规治疗组(P<0.05);2静脉溶栓组患者90d后预后良好率高于常规治疗组(58.4%vs42.3%,2=4.423,P<0.05)。两组之间死亡率差异没有统计学意义(12.5%vs19.2%,2=1.487,P>0.05;3多因素回归分析显示治疗前NHISS评分(OR:1.517,1.2142.261,P<0.05)、心房颤动病史(OR:1.431,1.2792.041,P<0.05)是溶栓后HT的独立危险因素。结论rt-PA静脉溶栓对发病6h内的ACI患者的疗效优于常规治疗;治疗前NHISS评分、有心房颤动病史是影响溶栓后HT的独立危险因素。

Objective To investigate the efficacy and the risk factors of hemorrhagic transformation( HT)of intravenous thrombolysis with recombinant tissue plasminogen activator( rt-PA) in acute cerebral infarction(ACI).Method Choose 174 patients with ACI within 6 hours from the onset. According to the different treatment methods,the patients were classified into intravenous thrombolysis group and the conventional therapy group. The National Institutes of Health Stroke Scale( NHISS) score were compared before and after treatment of 24 hours,14 days and Modified Rankin Scale(mRS) scores 90 days after onset between the two groups were also compared , and recorded adverse reactions. The different influencing factors between patients with and without hemorrhagic complications were compared. Use multivariate regression analysis to determine the independent risk factors for HT after thrombolytic therapy. Results ① After thrombolysis of 24 hours, 14 days, the NIHSS score was significantly lower than before thrombolysis(P<0.05). In conventional therapy group, after treatment of 24 hours, 14 days, The NHISS score reduction is not obvious(P>0.05). There were significant differences of NHISS scores between intravenous thrombolysis group and conventional therapy group at each time point(P<0.05). ② There were statistically significance in the rate of mRS 0-1 scores between the two groups(58.4%vs42.3%,2=4.423, P<0.05), while there were no statistically significance in the mortality rate(12.5%vs19.2%, 2=1.487, P>0.05). ③ Multivariate regression analysis suggests that the baseline NHISS score(OR:1.517,1.2142.261,P<0.05), atrial fibrillation(OR:1.431,1.2792.041,P<0.05) were independent risk factors for HT. Conclusion Intravenous thrombolysis with rt-PA in ACI is more effective than conventional treatments. the baseline NHISS score and atrial fibrillation were independent risk factors for HT.