急性缺血性脑卒中静脉溶栓后出血转化及预后影响因素分析

Analysis of hemorrhage transformation and prognostic factors after intravenous thrombolysis in acute ischemic stroke

目的分析急性缺血性脑卒中患者静脉溶栓后出血转化及预后相关危险因素。方法将78例经静脉溶栓治疗的急性缺血性脑卒中患者按是否出现出血转化分组,出血组共20例,无出血组共58例;根据预后情况分组,预后不良组共28例,预后良好组共50例。分组方法均为质量分组法。分析临床资料,找出影响出血转化、预后的独立危险因素。结果 (1)单因素分析发现出血组溶栓前NIHSS分值较无出血组高,溶栓后2h NIHSS分值、溶栓后最高收缩压较无出血组高,房颤发生率较无出血组,基线APTT较无出血组低,差异有统计学意义(P <0.05)。(2)与预后良好组比较,预后不良组平均年龄更大,溶栓前NIHSS分值、溶栓后2h NIHSS分值更高,房颤发生率、出血转化率更高,差异有统计学意义(P <0.05)。(3)Logistic回归分析发现溶栓后2h NIHSS高分值、前循环梗死、溶栓后最高收缩压过高是独立危险因素;溶栓后2h NIHSS高分值、出血转化为不良预后独立影响因素,差异有统计学意义(P <0.05)。结论急性缺血性脑卒中静脉溶栓后2h NIHSS分值较高、前循环梗死、溶栓后自高收缩压过高是发生出血转化独立危险因素;溶栓后2h NIHSS分值过高、出血转化是不良预后独立危险因素。

Objective To analyze hemorrhage transformation and prognostic factors after intravenous thrombolysis in acute ischemic stroke.Methods 78 patients with acute ischemic stroke treated by intravenous thrombolysis were divided into bleeding group with 20 patients and non-bleeding group with 58 patients according to whether there was bleeding transformation;and divided into poor prognosis group with 28 patients and good prognosis group with 50 patients.Mass Grouping Method is used in grouping.Clinical data was analyzed so as to find independent risk factors affecting the transformation and prognosis of hemorrhage.Results(1)Unifactorial analysis showed that the score of NIHSS before thrombolysis was higher in the bleeding group than that in the non-bleeding group;The score of 2h NIHSS after thrombolysis and the maximum systolic blood pressure after thrombolysis were higher than that in the non-bleeding group;And the baseline APTT was lower than that in the non-bleeding group(P<0.05).(2)Compared with the good prognosis group,the average age of the poor prognosis group was older,the scores of NIHSS before thrombolysis and 2h NIHSS after thrombolysis were higher,and the incidence of atrial fibrillation and bleeding conversion rate were higher(P<0.05).(3)Logistic regression analysis showed that high score of 2hNIHSS,anterior circulation infarction and high systolic blood pressure after thrombolysis were independent risk factors.After thrombolysis,2h high score of NIHSS and hemorrhage were independent influencing factors for poor prognosis.Conclusion High NIHSS score of 2h after intravenous thrombolysis in acute ischemic stroke,anterior circulation infarction and high systolic blood pressure after thrombolysis are independent risk factors for hemorrhage transformation.After thrombolysis,2h high NIHSS score and bleeding transformation are independent risk factors for poor prognosis.