急性缺血性卒中患者静脉溶栓后继发脑出血的影响因素分析

Analysis of influencing factors of secondary cerebral hemorrhage after intravenous thrombolysis in acute ischemic stroke

目的:分析急性缺血性卒中(AIS)患者静脉溶栓后继发脑出血的影响因素。方法:回顾性分析2018年1月至2019年12月该院收治的124例AIS患者的临床资料,对可能导致AIS患者静脉溶栓后继发脑出血的相关因素进行单因素及Logistic回归分析。结果:124例AIS患者溶栓后24 h内继发脑出血37例,发生率为29.84%;单因素分析结果显示,年龄、性别、既往AIS病史、发病至溶栓时间、合并糖尿病或高脂血症与继发脑出血无明显相关性(P>0.05);体温、血浆纤维蛋白原(Fib)水平、美国国立卫生研究院卒中量表(NIHSS)评分、梗死类型及合并房颤与溶栓后继发脑出血存在明显相关性(P<0.05);Logistic回归分析结果显示,体温>37℃、Fib>4 g/L、NIHSS评分>15分、前循环梗死及合并房颤是AIS患者静脉溶栓后继发脑出血的独立危险因素(OR>1,P<0.05)。结论:体温>37℃、Fib>4 g/L、NIHSS评分>15分、前循环梗死及合并房颤是AIS患者静脉溶栓后继发脑出血的独立危险因素,临床应针对此类患者提前采取预防措施。

Objective:To analyze influencing factors of secondary cerebral hemorrhage after intravenous thrombolysis in acute ischemic stroke(AIS).Methods:The clinical data of 124 AIS patients admitted to the hospital from January 2018 to December 2019 were retrospectively analyzed.The univariate analysis and Logistic regression analysis were performed on the related factors that may cause secondary cerebral hemorrhage after intravenous thrombolysis in the AIS patients.Results:Among the 124 AIS patients,37 cases of cerebral hemorrhage occurred within 24 hours after thrombolysis with an incidence rate of 29.84%.The univariate analysis showed that there were no significant correlations among age,gender,previous AIS history,time from onset to thrombolysis,diabetes or hyperlipidemia and secondary cerebral hemorrhage(P>0.05);the temperature and the plasma fibrinogen(Fib)level,the National Institutes of Health Stroke Scale(NIHSS)score,the type of infarction and the combined atrial fibrillation were significantly correlated with cerebral hemorrhage after thrombolysis(P<0.05).Logistic regression analysis showed that body temperature>37℃,Fib>4 g/L,NIHSS score>15 points,anterior circulation infarction and combined atrial fibrillation were the independent influencing factors of bleeding after intravenous thrombolysis in the AIS patients(OR>1,P<0.05).Conclusions:Body temperature>37℃,Fib>4 g/L,NIHSS score>15 points,anterior circulation infarction and combined atrial fibrillation are the independent influencing factors of secondary cerebral hemorrhage after intravenous thrombolysis in the AIS patients.Therefore,clinical measures should be taken in advance for these patients.