急性脑梗死患者阿替普酶静脉溶栓治疗致颅内出血的影响因素

Influencing factors of intracranial hemorrhage induced by intravenous Alteplase thrombolytic therapy in patients with acute cerebral infarction

目的探讨急性脑梗死患者阿替普酶静脉溶栓治疗致颅内出血(ICH)的影响因素。方法对齐齐哈尔医学院附属第一医院2021年1月至2022年11月收治的44例急性脑梗死静脉溶栓治疗患者进行回顾性分析。收集患者相关临床资料,根据应用阿替普酶静脉溶栓治疗后有无ICH,将患者分为ICH组与无ICH组,对溶栓治疗后ICH影响因素进行分析。结果44例患者中,14例患者阿替普酶静脉溶栓治疗后发生ICH,发生率为31.8%。ICH组和无ICH组患者的性别、年龄、吸烟、饮酒、糖尿病、既往抗血栓药物、发病至溶栓时间(ONT)、TOAST分型、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、基线血糖水平、低密度脂蛋白胆固醇增高发生率、高同型半胱氨酸发生率比较,差异无统计学意义(P>0.05);两组的高血压、既往缺血性卒中发生率比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄、ONT、缺血性卒中史是阿替普酶溶栓后ICH的独立影响因素(P<0.05)。结论急性脑梗死患者应用阿替普酶溶发生ICH,与年龄、高血压、ONT、缺血性卒中史诸多因素相关,临床上应重点关注具有这些危险因素的患者,及时进行干预。

Objective To investigate the influential factors of intracranial hemorrhage(ICH)induced by Alteplase intravenous thrombolytic therapy in patients with acute cerebral infarction.Methods A retrospective analysis was performed on 44 cases of acute cerebral infarction treated with intravenous thrombolysis in the First Affiliated Hospital of Qiqihar Medical College from January 2021 to November 2022.Relevant clinical data of patients were collected.According to the presence or absence of ICH after intravenous thrombolytic therapy with Alteplase,patients were divided into ICH group and ICH free group,and the influencing factors of ICH after thrombolytic therapy were analyzed.Results Among the 44 patients,14 had ICH after intravenous thrombolytic therapy with Alteplase(31.8%).Gender,age,smoking,alcohol consumption,diabetes,past antithrombotic drugs,onset-to-needle time(ONT),TOAST classification,National Institutes of Health stroke scale(NIHSS)score before thrombolysis,baseline blood glucose level,incidence of elevated low-density lipoprotein cholesterol,and incidence of hyperhomocysteine were compared between patients in the ICH and non-ICH groups,and there were no statistical significances(P>0.05).There were significant differences in the incidence of hypertension and previous ischemic stroke between the two groups(P<0.05).Multivariate logistic regression analysis showed that age,ONT and history of ischemic stroke were independent influencing factors for ICH after Alteplase thrombolysis(P<0.05).Conclusion The use of Alteplase in acute cerebral infarction patients with ICH is related to age,hypertension,ONT,ischemic stroke history and many factors,clinical attention should be paid to patients with these risk factors,timely intervention.