急性脑梗死患者阿替普酶溶栓后颅内出血风险因素最佳证据总结

Summary of the Optimal Evidence of Risk Factors for Intracranial Hemorrhage after Throm⁃bolysis with Alteplase in Patients with Acute Ischemic Stroke

目的:选取国内外急性脑梗死患者阿替普酶溶栓后颅内出血风险因素的相关证据,并对最佳证据进行总结,为降低急性脑梗死溶栓术后颅内出血风险提供参考。方法:系统检索国内外数据库及相关协会官方网站中关于急性脑梗死患者阿替普酶溶栓颅内出血风险因素的所有证据,包括相关指南、最佳临床实践、专家共识、相关证据总结、系统评价及各类标准;检索时限为2010年1月1日~2022年12月;对检索结果进行分析总结。结果:共纳入14篇文献,包括指南6篇、专家共识1篇、系统评价4篇、科学声明3篇。通过对14篇相关文献按照科学步骤进行分析,得出共有8项影响因素与急性脑梗死患者使用阿替普酶静脉溶栓后发生颅内出血相关:时间窗、高血压、高血糖、入院美国国立卫生院脑卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、心房颤动、溶栓前中性粒细胞百分比、大面积梗死、溶栓前头颅CT有早期缺血改变。结论:本研究总结了急性脑梗死患者在使用阿替普酶溶栓后发生颅内出血的相关风险因素的最佳证据,为降低其发生率提供了循证依据。

Objective:To select the relevant evidence on risk factors for intracranial hemorrhage(ICH)after thrombolysis with alteplase in patients with acute ischemic stroke(AIS)at home and abroad,and summarize the best evidence to provide a reference for reducing the risk of ICH after thrombolysis in patients with AIS.Meth⁃ods:Systematically search all evidence related to risk factors for ICH after alteplase thrombolysis in patients with AIS from domestic and foreign databases and official websites of relevant associations,including relevant guidelines,best clinical practice,expert consensus,summary of relevant evidence,systematic reviews,and vari-ous standards.The search time limit is January 1,2010-December 31,2022.Then analyze and summarize the search results.Results:A total of 14 articles were included,including 6 guidelines,1 expert consensus,4 sys-tematic reviews,and 3 scientific statements.Through the analysis of the 14 related literature according to the sci-entific steps,it was concluded that there are 8 factors related to ICH after alteplase thrombolysis in patients with AIS:time window,hypertension,hyperglycemia,admission National Institutes of Health Stroke Scale(NIHSS)score,atrial fibrillation,neutrophil percentage before thrombolysis,large area infarction,early ischemic changes on head CT before thrombolysis.Conclusion:This study summarizes the best evidence on risk factors related to ICH after alteplase thrombolysis in patients with AIS,providing an evidence-based basis for reducing its incidence.