作　　者： (王茂湘）; (范铁平）; (王晓东）; (王晓红）; (赵旭生）; (邓勇）; (彭道勇）;

机构地区： 116033,大连市中心医院神经内科

出　　处： 《中国医师进修杂志》

摘　　要： 目的 探讨急性脑梗死患者行静脉溶栓后出血转化(HT)的危险因素.方法 回顾性分析246例发病在4.5 h内进行静脉溶栓的脑梗死患者的临床资料,根据溶栓后24~36 h头部CT检查结果,将患者分为HT组和非HT组,对年龄、性别、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、是否具有长期吸烟、饮酒、高血压、糖尿病、心房颤动病史等因素进行单因素分析和Logistic回归分析.结果 HT组与非HT组患者在年龄、性别构成、吸烟史、饮酒史、发病至溶栓时间、糖尿病病史方面比较差异无统计学意义(P>0.05).两组溶栓前NIHSS评分[(14.53±6.06)分比(9.98±6.26)分,P=0.000]、高血压病史[86.1%(31/36)比70.0%(147/210),P=0.046]及心房颤动病史[63.9%(23/36)比24.3%(51/210),P=0.000]比较差异有统计学意义.Logistic回归分析显示,溶栓前NIHSS评分(OR=1.079,95%CI=1.014~1.147,P=0.016)、心房颤动病史(OR=3.298,95%CI=1.481~7.345,P=0.003)是急性脑梗死静脉溶栓后发生HT的危险因素.结论 溶栓前NIHSS评分高、心房颤动是急性脑梗死患者静脉溶栓后发生HT的危险因素. Objective To investigate the risk factors of hemorrhagic transformation (HT) following thrombolytic therapy in acute cerebral infarct patients. Methods The clinical data of 246 cases with acute cerebral infarct treated with rt-PA within 4.5 h from the onset were reviewed. According to the results of brain CT imaging after intravenous thrombolysis for 24-36 h, the patients were divided into HT group and non HT group. The factors including age, gender, NIHSS scores, drinking, smoking, hypertension, diabetes, atrial fibrillation. The univariate analysis and Losgistic regression analysis were further assessed. Results The results of univariate analysis indicated that there were no significant differences between the two groups in age, gender, smoking , drinking, time from onset to thrombolysis, diabetes (P > 0.05), but there were significant differences between two groups in NIHSS scores [(14.53 ± 6.06) scores vs.(9.98 ± 6.26) scores, P = 0.000], hypertension [86.1%(31/36) vs.70.0%(147/210), P = 0.046] and atrial fibrillation (63.9%(23/36) vs. 24.3%(51/210), P = 0.000)Logistic regression analysis showed that NIHSS scores (OR = 1.079, 95% CI = 1.014- 1.147, P = 0.016) and atrial fibrillation (OR=3.298, 95%CI=1.481-7.345, P=0.003) were the risk factors associated with hemorrhagic transformation after intravenous thrombolysis for acute cerebral infarction. Conclusions NIHSS scores and atrial fibrillation are the risk factors associated with HT after thrombolytic therapy in acute cerebral infarct patients.

分 类 号： [Z1]