脑梗死静脉溶栓后继发脑出血现状及其高危因素调查

Investigation of the status and high-risk factors of cerebral hemorrhage after intravenous thrombolysis in cerebral infarction

目的探讨脑梗死静脉溶栓后继发脑出血现状及其高危因素。方法选取2015年4月至2019年10月在我院进行脑梗死静脉溶栓治疗的患者357例为研究对象,于治疗后24 h进行头部CT或MRI检查,根据是否继发脑出血分为脑出血组及非脑出血组,对两组患者性别、年龄、高血压史、糖尿病史、同型半胱氨酸水平、梗死面积、发病至溶栓时间、是否伴有房颤及治疗前NIHSS评分进行单因素分析及多因素logistic回归分析,探究继发脑出血高危因素。结果357例患者中有60例出现继发脑出血,发生率16.81%,且脑出血类型以出血性梗死为主,占全部患者的9.52%。单因素分析显示,脑梗死静脉溶栓后继发脑出血与性别、年龄、高血压史、同型半胱氨酸水平无关(P>0.05),与糖尿病史、大面积梗死、发生房颤、发病至溶栓时间较长及治疗前NIHSS评分较高存在统计学意义(P<0.05);多因素logistic回归分析显示,大面积梗死、发生房颤、发病至溶栓时间及治疗前NIHSS评分是脑梗死静脉溶栓治疗后继发脑出血的独立危险因素(P<0.05)。结论脑梗死静脉溶栓后继发脑出血危险因素包括梗死面积、房颤、发病至溶栓时间及治疗前NIHSS评分,医护人员应根据具体情况采取相应干预措施,避免脑梗死在静脉溶栓治疗后出现脑出血等症状。

Objective To explore the status and high-risk factors of cerebral hemorrhage after intravenous thrombolysis in cerebral infarction.Methods To select 357 cases of patients who underwent intravenous thrombolytic therapy for cerebral infarction in our hospital from April 2015 to October 2019 as the study objects.The head CT or MRI examinations were performed 24 hours after the treatment,and they was divided into a cerebral hemorrhage group and non-cerebral hemorrhage group according to whether secondary cerebral hemorrhage occurred.The gender,age,history of hypertension,history of diabetes,homocysteine level,infarct size,time from onset to thrombolysis,whether there was atrial fibrillation and NIHSS score before treatment were conducted univariate analysis and multivariate logistic regression analysis to explore high-risk factors for secondary cerebral hemorrhage.Results There were 60 cases of secondary cerebral hemorrhage in the 357 cases of patients,the incidence was 16.81%,and hemorrhagic infarction was the main type of cerebral hemorrhage,accounting for 9.52%of all patients.Univariate analysis showed that the cerebral hemorrhage after intravenous thrombolysis of cerebral infarction had nothing to do with the gender,age,history of hypertension and homocysteine level(P>0.05),but it was statistically significant with history of diabetes,large area infarction,occurrence of atrial fibrillation,longer time from onset to thrombolysis,and higher NIHSS score before treatment(P<0.05).Multivariate logistic regression analysis showed that the large-area infarction,occurrence of atrial fibrillation,time from onset to thrombolysis,and NIHSS score before treatment were the independent risk factors for cerebral hemorrhage after intravenous thrombolytic therapy for cerebral infarction(P<0.05).Conclusion The infarct size,atrial fibrillation,time from onset to thrombolysis,and NIHSS score before treatment were the risk factors for cerebral hemorrhage after intravenous thrombolytic therapy for cerebral infarction.Medical staff should take corresponding intervention measures according to the specific situation to avoid cerebral hemorrhage after intravenous thrombolytic therapy.