中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2011年
11期
754-758
,共5页
苏敏%杨卫新%王万华%曹勇军%产涛声%江选飞%孔岩%刘春风
囌敏%楊衛新%王萬華%曹勇軍%產濤聲%江選飛%孔巖%劉春風
소민%양위신%왕만화%조용군%산도성%강선비%공암%류춘풍
脑出血%卒中%组织型纤溶酶原激活物%血栓溶解疗法%预后%危险因素
腦齣血%卒中%組織型纖溶酶原激活物%血栓溶解療法%預後%危險因素
뇌출혈%졸중%조직형섬용매원격활물%혈전용해요법%예후%위험인소
Cerebral hemorrhage%Stroke%Tissue plasminogen activator%Thrombolytic therapy%Prognosis%Risk factors
目的 探讨急性缺血性卒中重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后发生出血性转化(HT)的可能危险因素以及这些危险因素对患者预后的影响.方法 128例急性缺血性卒中患者发病6h内接受rt-PA静脉溶栓治疗,选取溶栓前临床和实验室资料,通过比较HT组与非HT组之间的差异,筛选与HT相关的可能危险因素,并进一步通过Logistic回归分析影响HT及其预后的独立危险因素.结果 128例溶栓患者有29例继发HT(22.66％),其中16例为症状性脑出血(12.50％),死亡2例,占HT的6.90％.Logistic回归分析表明房颤(OR=1.293,95％ CIl.224 ～1.589,P=0.00l)、早期CT改变(OR=2.452,95％ CI 1.132～3.309,P=0.034)、基线舒张压≥100 mm Hg(1 mm Hg=0.133 kPa,OR=9.265,95％ CI 1.435 ～ 59.836,P=0.019)、基线血糖≥11.1 mmol/L(OR=3.037,95％ CI0.252 ～ 57.593,P=0.047)、NIHSS评分＞15分(OR=8.752,95％CI 1.035 ～30.285,P=0.023)和溶栓时间窗＞3h(OR=98.74,95％CI 5.067 ～ 186.120,P=0.002)6项为HT独立危险因素,其中基线血糖≥11.1 mmol/L(OR=3.265,95％ CI 0.435 ～ 59.863,P=0.045)、NIHSS评分＞15分(OR=10.453,95％ CI 5.647～38.185,P=0.003)和溶栓时间窗＞3h(OR =2.541,95％CI 1.098 ～51.086,P=0.017)影响了HT患者的预后.结论 溶栓前的舒张压、血糖水平、神经功能缺损程度、CT低密度改变或水肿占位效应、房颤和溶栓时间窗是HT的独立危险因素,其中基线血糖水平、神经功能缺损程度和溶栓时间窗影响了溶栓后HT患者的预后.
目的 探討急性缺血性卒中重組組織型纖溶酶原激活劑(rt-PA)靜脈溶栓後髮生齣血性轉化(HT)的可能危險因素以及這些危險因素對患者預後的影響.方法 128例急性缺血性卒中患者髮病6h內接受rt-PA靜脈溶栓治療,選取溶栓前臨床和實驗室資料,通過比較HT組與非HT組之間的差異,篩選與HT相關的可能危險因素,併進一步通過Logistic迴歸分析影響HT及其預後的獨立危險因素.結果 128例溶栓患者有29例繼髮HT(22.66％),其中16例為癥狀性腦齣血(12.50％),死亡2例,佔HT的6.90％.Logistic迴歸分析錶明房顫(OR=1.293,95％ CIl.224 ～1.589,P=0.00l)、早期CT改變(OR=2.452,95％ CI 1.132～3.309,P=0.034)、基線舒張壓≥100 mm Hg(1 mm Hg=0.133 kPa,OR=9.265,95％ CI 1.435 ～ 59.836,P=0.019)、基線血糖≥11.1 mmol/L(OR=3.037,95％ CI0.252 ～ 57.593,P=0.047)、NIHSS評分＞15分(OR=8.752,95％CI 1.035 ～30.285,P=0.023)和溶栓時間窗＞3h(OR=98.74,95％CI 5.067 ～ 186.120,P=0.002)6項為HT獨立危險因素,其中基線血糖≥11.1 mmol/L(OR=3.265,95％ CI 0.435 ～ 59.863,P=0.045)、NIHSS評分＞15分(OR=10.453,95％ CI 5.647～38.185,P=0.003)和溶栓時間窗＞3h(OR =2.541,95％CI 1.098 ～51.086,P=0.017)影響瞭HT患者的預後.結論 溶栓前的舒張壓、血糖水平、神經功能缺損程度、CT低密度改變或水腫佔位效應、房顫和溶栓時間窗是HT的獨立危險因素,其中基線血糖水平、神經功能缺損程度和溶栓時間窗影響瞭溶栓後HT患者的預後.
목적 탐토급성결혈성졸중중조조직형섬용매원격활제(rt-PA)정맥용전후발생출혈성전화(HT)적가능위험인소이급저사위험인소대환자예후적영향.방법 128례급성결혈성졸중환자발병6h내접수rt-PA정맥용전치료,선취용전전림상화실험실자료,통과비교HT조여비HT조지간적차이,사선여HT상관적가능위험인소,병진일보통과Logistic회귀분석영향HT급기예후적독립위험인소.결과 128례용전환자유29례계발HT(22.66％),기중16례위증상성뇌출혈(12.50％),사망2례,점HT적6.90％.Logistic회귀분석표명방전(OR=1.293,95％ CIl.224 ～1.589,P=0.00l)、조기CT개변(OR=2.452,95％ CI 1.132～3.309,P=0.034)、기선서장압≥100 mm Hg(1 mm Hg=0.133 kPa,OR=9.265,95％ CI 1.435 ～ 59.836,P=0.019)、기선혈당≥11.1 mmol/L(OR=3.037,95％ CI0.252 ～ 57.593,P=0.047)、NIHSS평분＞15분(OR=8.752,95％CI 1.035 ～30.285,P=0.023)화용전시간창＞3h(OR=98.74,95％CI 5.067 ～ 186.120,P=0.002)6항위HT독립위험인소,기중기선혈당≥11.1 mmol/L(OR=3.265,95％ CI 0.435 ～ 59.863,P=0.045)、NIHSS평분＞15분(OR=10.453,95％ CI 5.647～38.185,P=0.003)화용전시간창＞3h(OR =2.541,95％CI 1.098 ～51.086,P=0.017)영향료HT환자적예후.결론 용전전적서장압、혈당수평、신경공능결손정도、CT저밀도개변혹수종점위효응、방전화용전시간창시HT적독립위험인소,기중기선혈당수평、신경공능결손정도화용전시간창영향료용전후HT환자적예후.
Objective To investigate risk factors and prognosis of hemorrhagic transformation(HT)in acute cerebral infarction patients treated by intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA).Methods All 128 patients with acute cerebral infarction were treated with intravenous rtPA within 6 hours from stroke onset.The clinic records and laboratory datas of pre-and post-treatment were statistically analyzed between HT group and non-HT group to find potential risk factors to HT and contributors of prognosis.Results HT occurred in 29 patients(22.66％),including 16 patients with symptomatic ICH(12.50％)and 2 patients died(6.90％ of HT).Logistic regression analysis showed that history of atrial fibrillation(OR =1.293,95％ CI 1.224-1.589,P =0.001),CT density changes with mass effect or edema(OR =2.452,95％ CI 1.132-3.309,P =0.034),diastolic blood pressure ≥ 100 mm Hg before thrombolytic therapy(1 mm Hg =0.133 kPa,OR =9.265,95％ CI 1.435-59.836,P =0.019),blood glucose ≥ 11.1 mmol/L(OR =3.037,95％ CI 0.252-57.593,P =0.047),NIHSS score ＞ 15 points (OR =8.752,95％ CI 1.035-30.285,P =0.023)and thrombolysis time ＞ 3 h(OR =98.74,95％ CI 5.067-186.120,P =0.002)are independent risk factors for HT; among these factors,baseline blood glucose(OR =3.265,95 ％ CI 0.435-59.863,P =0.045),NIHSS score(OR =10.453,95 ％ CI 5.647-38.185,P =0.003)and thrombolysis time(OR =2.541,95％ CI 1.098-51.086,P =0.017)also are prediction factors of the prognosis of HT.Conclusion Risk factors associated with HT are diastolic blood pressure before thrombolysis,glucose level,degree of neurological deficits,CT early changes,atrial fibrillation and thrombolytic time.Glucose level,neurological deficits and thrombolysis time affects the prognosis of patients.
