急性缺血性脑卒中阿替普酶静脉溶栓后24小时内出血并发症分析

Retrospective analysis of hemorrhage complications within 24 hours after intravenous thrombolysis of atropase in acute ischemic stroke

目的分析阿替普酶静脉溶栓治疗急性脑梗死24小时内出血并发症和相关风险因素。方法收集我科在时间窗内的阿替普酶静脉溶栓治疗急性脑梗死200例患者资料,包括年龄、性别、既往病史、不良嗜好、血压、血糖、血脂、肝肾功能、血小板计数、凝血功能等,分析溶栓后出血并发症情况和相关影响因素。结果200例溶栓患者中发生系统和颅内出血41例,出血率为20.5%(41/200),脑内出血转换率仅为1.5%(3/200)。包括牙龈出血21例、舌部出血9例、舌部+牙龈出血2例、皮下出血1例、消化道出血3例、泌尿道出血1例、梗死灶内出血2例、舌部+梗死灶内出血1例、脑室内出血1例;所有出血患者中无严重致残、致死病例。回归分析结果显示,心房颤动是患者溶栓后发生出血的独立危险因素(P<0.05)。结论阿替普酶静脉溶栓出血转换率非常低,心房颤动是患者溶栓后发生出血的独立危险因素。阿替普酶静脉溶栓治疗急性脑梗死是有效、安全的,但治疗要个体化。

Objective To retrospectively investigate the hemorrhage complications within 24 hours after intravenous thrombolysis of atropase in acute ischemic stroke(AIS).Methods The data of 200 AIS patients treated by intravenous thrombolysis of atropase were collected,including age,sex,past medical history,bad hobby,blood sugar,blood pressure,blood fat,liver and kidney function,platelet count,coagulation functionand so on.Bleeding complications and related risk factors were analyzed after intravenous thrombolytic therapy.Results Systematic and intracranial hemorrhage occurred in 41 of 200 patients with thrombolysis,with a bleeding rate of 20.5%(41/200)and a cerebral hemorrhage conversion rate of only 1.5%(3/200),There were 21 cases of gingival bleeding,9 cases of tongue bleeding,2 cases of tongue and gingival bleeding,1 case of subcutaneous bleeding,3 cases of gastrointestinal bleeding,1 case of urinary tract bleeding,2 cases of intrainfarction focus bleeding,1 case of tongue and intrainfarction focus bleeding,and 1 case of intraventricular hemorrhage.And no severely disabled or fatal case caused by bleeding was found.Multivariate regression analysis showed that atrial fibrillation was an independent risk factor for bleeding after thrombolysis(P<0.05).Conclusion The bleeding conversion rate of intravenous thrombolysis of atropase is very low,and atrial fibrillation is an independent risk factor for bleeding after thrombolysis.Intravenous thrombolysis of atropase is effective and safe for acute cerebral infarction,but the treatment should be individualized.