老年急性缺血性脑卒中患者机械取栓后出血转化的危险因素分析

Analysis of risk factors for hemorrhagic transformation in elderly patients with acute ischemic stroke after mechanical thrombectomy

目的探讨老年急性缺血性脑卒中患者机械取栓后出血转化相关的危险因素。方法收集2019年4月至2022年12月于南京医科大学第一附属医院(江苏省人民医院)接受机械取栓的167例老年急性缺血性脑卒中患者的临床资料,按照术后住院期间是否发生出血转化将其分为出血组(n=41)和对照组(n=126)。收集两组患者的一般信息、入院时的检查结果、化验结果、机械取栓相关指标以及住院期间复查的影像学结果,分析老年急性缺血性脑卒中患者机械取栓后出血转化的危险因素。结果单因素分析结果显示,出血组患者年龄、收缩压、C反应蛋白水平、糖尿病比例、取栓次数均高于对照组患者,差异均有统计学意义(P<0.05)。多因素分析结果显示,年龄>70岁、收缩压≥140 mmHg(1 mmHg=0.133 kPa)、C反应蛋白水平>5 mg/L、糖尿病以及取栓次数≥2次均是老年急性缺血性脑卒中患者机械取栓后出血转化相关的独立危险因素(P<0.05)。结论年龄、血压、糖尿病、血压、C反应蛋白水平以及取栓次数均与老年急性缺血性脑卒中患者机械取栓后发生出血转化有关,临床医师可以根据上述指标对患者进行针对性的筛查,做好监测与预防。

Objective To investigate the risk factors related to hemorrhagic transformation in elderly patients with acute ischemic stroke after mechanical thrombectomy.Method The clinical data of 167 elderly patients with acute ischemic stroke who underwent mechanical thrombectomy in the First Affiliated Hospital with Nanjing Medical University(Jiangsu Provincial Hospital)from April 2019 to December 2022 were collected.They were divided into hemorrhage group(n=41)and control group(n=126)according to whether hemorrhagic transformation occurred during postoperative hospitalization.The general data,examination results at admission,laboratory results,indicators related to mechanical thrombectomy,and imaging results of reexamination during hospitalization of the two groups of patients were collected.The risk factors of hemorrhagic transformation after mechanical thrombectomy in elderly patients with acute ischemic stroke were also analyzed.Result The results of univariate analysis showed that the age,systolic blood pressure,C-reactive protein level,proportion of diabetes mellitus,and times of thrombectomy in the bleeding group were higher than those in the control group,the differences were statistically significant(P<0.05).The results of multivariate analysis showed that age>70 years old,systolic blood pressure≥140 mmHg(1 mmHg=0.133 kPa),C-reactive protein level>5 mg/L,diabetes,and times of thrombectomy≥2 were all independent risk factors for hemorrhagic transformation in elderly patients with acute ischemic stroke after mechanical thrombectomy(P<0.05).Conclusion Age,blood pressure,diabetes,blood pressure,C-reactive protein level,and thrombectomy times are all related to hemorrhagic transformation after mechanical thrombectomy in elderly patients with acute ischemic stroke.Clinical workers should conduct targeted screening for patients based on the above indicators,and pay great attention to monitoring and prevention.