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目的分析急性缺血性脑卒中静脉溶栓后出血性转化危险因素,为出血性转化预防提供依据。方法对2013年2月—2016年10月本院收治的急性脑梗死静脉溶栓187例患者进行回顾性分析,将发生出血性转化的患者纳入病例组,未发生出血性转化的患者纳入对照组,对比临床资料,进行因素分析。结果男性、有脑卒中病史、大脑中动脉梗死、颅内压升高、合并高血压、合并糖尿病、合并高脂血症、体温上升、血压上升、入院高血糖、纤维蛋白原阳性的百分率均为病例组患者高于对照组患者(P<0.05);多因素logistic回归性分析,结果显示大面积脑梗死OR=5.676,95%CI(13.964)、大脑中动脉梗死OR=2.764,95%CI(1.387~4.261)、体温上升OR=3.002,95%CI(1.672~6.261)、血压上升OR=2.431,95%CI(1.345~13.576)、入院高血糖OR=3.785,95%CI(1.874~20.571)、发病到溶栓时间<6 h OR=1.764,95%CI(1.275~5.676)成为独立危险因素(P<0.05)。结论急性缺血性脑卒中静脉溶栓后出血性转化影响因素较多,特别关注大面积梗死、中动脉梗死患者,加强急诊管理,提高溶栓的落实效率,同时积极控制体温、血压、血糖。
Objective To analyze the risk factors of hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke, and provide evidence for the prevention of hemorrhagic transformation. Methods A retrospective analysis was performed on 187 patients with acute cerebral infarction received intravenous thrombolysis in our hospital from February 2013 to October 2016. Patients with hemorrhagic transformation were included in the case group and those without hemorrhagic transformation were included in the control group , Compare clinical data, carry on factor analysis. Results Male patients had a history of stroke, middle cerebral artery infarction, increased intracranial pressure, hypertension, diabetes mellitus, hyperlipidemia, elevated body temperature, elevated blood pressure, high blood glucose and fibrin-positive percentage Multivariate logistic regression analysis showed that large area cerebral infarction OR = 5.676,95% CI (13.964), middle cerebral artery infarct OR = 2.764, 95% CI (P <0.05) 1.387 ~ 4.261), OR = 3.002, 95% CI 1.672 ~ 6.261, OR = 2.431, 95% CI 1.345 ~ 13.576, OR = 3.785,95% CI 1.874 ~ 20.571, , The incidence of thrombolysis time <6 h OR = 1.764,95% CI (1.275 ~ 5.676) became an independent risk factor (P <0.05). Conclusion There are many influencing factors of hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke. Special attention is paid to the patients with large infarction and middle artery infarction. Emergency management is strengthened to improve the implementation efficiency of thrombolytic therapy while controlling body temperature, blood pressure and blood glucose.