阿替普酶在急性脑梗死静脉溶栓中出血转化的相关因素分析

被引：16

作者：

王琛 ^{[1
]}

陈国芳 ^{[2
]}

刘薇薇 ^{[2
]}

周生奎 ^{[2
]}

平蕾 ^{[2
]}

刘雷靖 ^{[2
]}

张冬梅 ^{[2
]}

机构：

[1] 徐州医科大学研究生学院

[2] 徐州市中心医院(徐州医科大学徐州临床学院东南大学医学院附属徐州医院南京中医药大学附属徐州中心医院)神经内科

来源：

中华临床医师杂志(电子版) | 2016年 / 10卷 / 21期

关键词：

门-针时间; 溶栓; 出血; 脑梗死;

D O I：

暂无

中图分类号：

R743.3 [急性脑血管疾病（中风）];

学科分类号：

1002 ;

摘要：

目的分析阿替普酶静脉溶栓治疗急性脑梗死(ACI)患者出现出血转化的相关危险因素。方法分析2014年1月至2016年5月徐州市中心医院收治的阿替普酶治疗ACI患者294例的临床资料,24 h内发生出血转化为转化组(19例,6.46%),余为非转化组(275例,93.54%)。对比两组一般资料,两组间计量资料比较采用t检验,计数资料比较采用χ2检验,用多因素Logistic逐步回归分析法分析脑梗死溶栓治疗出现脑出血转化的相关危险因素。结果 294例ACI患者中,转化组(19例)和非转化组(275例)的急诊收缩压(SBP)、急诊舒张压(DBP)、入院至静脉溶栓门针时间(DNT)、溶栓前美国国立卫生院卒中量表(NIHSS)评分差异具有统计学意义(P<0.05);两组患者的年龄、性别、基线血糖、基线凝血功能、基线血小板、既往口服抗血小板药物、心房颤动史、冠心病史、高血压病史、高脂血症史、糖尿病史、吸烟率差异均无统计学意义(P>0.05)。急诊SBP高水平(OR=1.627)、DNT越长(OR=1.015)、溶栓前NIHSS评分越高(OR=1.087)是发生出血转化的独立危险因素(P<0.05)。结论采用阿替普酶治疗的ACI患者,入院时的NIHSS评分高,高SBP,长DNT是溶栓后出血转化的预测因素。

引用

页码：3198 / 3202

页数：5

共 9 条

[1]

Prior antiplatelet agent use and outcomes after intravenous thrombolysis with recombinant tissue plasminogen activator in acute ischemic stroke: a meta‐analysis of cohort studies and randomized controlled trials[J] . Xiding Pan,Yubing Zhu,Danni Zheng,Yukai Liu,Feng Yu,Jie Yang.Int J Stroke . 2015 (3)

[2] Outcomes after stroke thrombolysis according to prior antiplatelet use [J].

Meseguer, Elena ;

Labreuche, Julien ;

Guidoux, Celine ;

Lavallee, Philippa C. ;

Cabrejo, Lucie ;

Sirimarco, Gaia ;

Valcarcel, Jaime G. ;

Klein, Isabelle F. ;

Amarenco, Pierre ;

Mazighi, Mikael .

INTERNATIONAL JOURNAL OF STROKE, 2015, 10 (02) :163-169

[3] Factors influencing haemorrhagic transformation in ischaemic stroke [J].

Alvarez-Sabin, Jose ;

Maisterra, Olga ;

Santamarina, Estevo ;

Kase, Carlos S. .

LANCET NEUROLOGY, 2013, 12 (07) :689-705

[4] Does Preexisting Antiplatelet Treatment Influence Postthrombolysis Intracranial Hemorrhage in Community-treated Ischemic Stroke Patients? An Observational Study [J].

Meurer, William J. ;

Kwok, Heemun ;

Skolarus, Lesli E. ;

Adelman, Eric E. ;

Kade, Allison M. ;

Kalbfleisch, Jack ;

Frederiksen, Shirley M. ;

Scott, Phillip A. .

ACADEMIC EMERGENCY MEDICINE, 2013, 20 (02) :146-154

[5]

Atrial Fibrillation in Ischemic Stroke: Predicting Response to Thrombolysis and Clinical Outcomes[J] . Gustavo Saposnik,David Gladstone,Roula Raptis,Limei Zhou,Robert G. Hart.Stroke . 2013 (1)

[6]

Timeliness of Tissue-Type Plasminogen Activator Therapy in Acute Ischemic Stroke: Patient Characteristics, Hospital Factors, and Outcomes Associated With Door-to-Needle Times Within 60 Minutes[J] . Gregg C. Fonarow,Eric E. Smith,Jeffrey L. Saver,Mathew J. Reeves,Deepak L. Bhatt,Maria V. Grau-Sepulveda,DaiWai M. Olson,Adrian F. Hernandez,Eric D. Peterson,Lee H. Schwamm.Circulation . 2011 (7)

[7] Neurological disease on the global agenda [J].

Johnston, S. Claiborne ;

Hauser, Stephen L. .

ANNALS OF NEUROLOGY, 2008, 64 (01) :A11-A12

[8]

Older Age Does Not Increase Risk of Hemorrhagic Complications after Intravenous and/or Intra-Arterial Thrombolysis for Acute Stroke[J] . Svetlna Pundik,Laurie McWilliams-Dunnigan,Kristine L. Blackham,H.L. Kirchner,Sophia Sundararajan,Jeffrey L. Sunshine,Robert W. Tarr,Warren R. Selman,Dennis M. Landis,Jose I. Suarez.Journal of Stroke and Cerebrovascular Diseases . 2008 (5)

[9] Intra-arterial thrombolysis in 100 patients with acute stroke due to middle cerebral artery occlusion [J].

Arnold, M ;

Schroth, G ;

Nedeltchev, K ;

Loher, T ;

Remonda, L ;

Stepper, F ;

Sturzenegger, M ;

Mattle, HP .

STROKE, 2002, 33 (07) :1828-1833

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