急性缺血性脑卒中的危险因素分布特点及支架取栓术后出血性转化的影响因素研究

Distribution characteristics of risk factors for acute ischemic stroke and influencing factors of hemorrhagic transformation after stent thrombectomy

目的回顾性分析急性缺血性脑卒中(AIS)患者的危险因素分布特点及其支架取栓术后出血性转化的影响因素,为临床预防AIS和支架取栓术后出血转化的预防提供参考依据。方法回顾性分析我院2019年1月至2021年6月期间收治的258例AIS患者的临床资料,其中行支架取栓术后出血性转化(HT)组62例,非HT组196例,对AIS常见危险因素、HT发生的可能影响因素进行单因素分析和Logistic多因素回归分析。结果(1)经对258例AIS患者的常见危险因素(既往心血管病史、家族性高血压史、脑卒中家族史、高血压病史、冠心病史、糖尿病史、高脂血症、吸烟史、饮酒史、高胆固醇、高甘油三酯、高尿酸血症、高同型半胱氨酸血症)进行pearson卡方检验分析,各项常见危险因素均为P<0.01,具有统计学意义;进行logistic多因素回归分析,各项常见危险因素均为AIS的独立危险因素。(2)经对258例AIS患者支架取栓术后发生HT的可能影响因素进行单因素分析,其中性别、高血压病史、心房颤动病史、饮酒史、闭塞血管(前循环)、术中推注替罗非班、术后收缩压这几项影响因素,均为P<0.05,具有统计学意义;性别、高血压病史、心房颤动病史、饮酒史、闭塞血管(前循环)、术中推注替罗非班、术后收缩压,进行logistic多因素回归分析,均为AIS患者支架取栓术后发生HT的独立危险因素。结论既往心血管病史、家族性高血压史、脑卒中家族史、高血压病史、冠心病史、糖尿病史、高脂血症、吸烟史、饮酒史、高胆固醇、高甘油三酯、高尿酸血症、高同型半胱氨酸血症等是AIS发病的主要危险因素,性别、高血压病史、心房颤动病史、饮酒史、闭塞血管(前循环)、术中推注替罗非班、术后收缩压是支架取栓术后发生HT的危险因素,临床预防和治疗中应对危险因素进行严密监测和管理。

Objective To retrospectively analyze the distribution characteristics of risk factors in patients with acute ischemic stroke(AIS)and the influencing factors of hemorrhagic transformation after stent thrombectomy,so as to provide reference basis for clinical prevention of AIS and timely detection of disease changes.Methods The clinical data of 258 patients with AIS treated in our hospital from January 2019 to June 2021 were analyzed retrospectively,including 62 cases in the hemorrhagic transformation(HT)group and 196 cases in the non HT group.The common risk factors of AIS and the possible influencing factors of HT were analyzed by univariate analysis and logistic regression analysis.Results(1)Pearson chi square analysis was performed on 258 common AIS risk factors(past history of cardiovascular disease,family history of hypertension,history of hypertension,history of coronary heart disease,history of diabetes,hyperlipidemia,smoking history,drinking history,hypercholesterolemia,hypertriglyceridemia,hyperhomocysteinemia),and 258 common risk factors(including previous history of cardiovascular disease,family history of stroke,history of diabetes,history of hyperlipidemia,smoking history,drinking history,high cholesterol,hypertriglyceridemia,hyperhomocysteinemia).The common risk factors were all P<0.01,with statistical significance;Logistic regression analysis showed that all common risk factors were independent risk factors of AIS.(2)The possible influencing factors of HT after stent thrombectomy in 258 patients with AIS were analyzed by univariate analysis,including gender,history of hypertension,history of atrial fibrillation,drinking history,occlusion of blood vessels(anterior circulation),intraoperative injection of tirofiban and postoperative systolic blood pressure(P<0.05);Gender,history of hypertension,history of atrial fibrillation,drinking history,occlusion of blood vessels(anterior circulation),intraoperative injection of tirofiban and postoperative systolic blood pressure were independent risk factors for HT after stent thrombectomy in AIS patients by logistic regression analysis.Conclusion Previous cardiovascular history,family history of hypertension,family history of stroke,history of hypertension,history of diabetes,history of hyperlipidemia,smoking,drinking history,high cholesterol,hypertriglyceridemia,hyperuricemia,and Gao Tong’s type of cysteinemia are the main risk factors for AIS.Gender,history of hypertension,history of atrial fibrillation,drinking history,etc.Occlusion of blood vessels(anterior circulation),intraoperative injection of tirofiban and postoperative systolic blood pressure are the risk factors of HT after stent thrombectomy.The risk factors should be closely monitored and managed in clinical prevention and treatment.