脑梗死静脉溶栓后继发脑出血发生现状及高危因素分析

摘要

目的:探讨脑梗死静脉溶栓后继发脑出血发生现状及高危因素.方法:选取2015年2月～2017年2月本地区脑梗死静脉溶栓患者528例,了解纳入脑梗死静脉溶栓患者一般资料、临床表现、实验室指标、治疗方法、辅助检查.引入二分类Logistic回归模型分析脑梗死静脉溶栓后继发脑出血高危因素,研究其相关性.结果:脑梗死静脉溶栓后患者继发脑出血34例,转化率6.44％.糖尿病病史、发病至溶栓时间>3 h、溶栓前NIHSS评分≥15分、溶栓前血糖>7.8 mmol/L、溶栓后收缩压>140 mmHg和大面积脑梗死者继发脑出血转化率与同组比较,差异有统计学意义(P<0.05).以患者静脉溶栓后继发脑出血作为因变量,糖尿病病史、发病至溶栓时间>3 h、溶栓前NIHSS评分≥15分、溶栓前血糖>7.8 mmol/L、溶栓后收缩压>140 mmHg和大面积脑梗死6项作为自变量,引入二分类Logistic回归模型中分析,结果显示上述指标均是脑梗死静脉溶栓后继发脑出血的独立风险因素.结论:脑梗死静脉溶栓后继发脑出血现状不容乐观,存在一定风险,而积极掌握和早期识别脑出血转化高危因素,有助于重点防控,从而降低脑梗死静脉溶栓后继发脑出血率、提高溶栓质量,促进患者早日康复.%Objective:To discuss the current status and high risk factors of secondary cerebral hemorrhage after cerebral infarction intravenous thrombolysis.Methods:Selected 528 patients with cerebral infarction intravenous thrombolysis in our region from February 2015 to February 2017 to understand the general data, clinical performance, laboratory indicators, treatment method, auxiliary examination of patients included in the cerebral infarction intravenous thrombolysis.Dichotomy Logistic regression model was introduced to analyze the high risk factors of secondary cerebral hemorrhage after cerebral infarction intravenous thrombolysis, and their correlation was researched.Results:There were 34 having secondary cerebral hemorrhage after cerebral infarction intravenous thrombolysis, with a conversion rate of 6.44％.Through comparison in the same group in history of diabetics, time from onset to thrombolysis>3h, score of NIHSS ≥15 before thrombolysis, blood glucose before thrombolysis >7.8 mmol/L, systolic pressure after thrombolysis >140 mmHg and secondary cerebral hemorrhage conversion rate of patients with large area of cerebral infarction, the difference was statistically significant (P<0.05).The patients'' secondary cerebral hemorrhage after intravenous thrombolysis as the dependent variable, and history of diabetics, time from onset to thrombolysis>3 h, score of NIHSS ≥15 before thrombolysis, blood glucose before thrombolysis >7.8 mmol/L, systolic pressure after thrombolysis >140 mmHg and large area of cerebral infarction as the independent variables were introduced in the Dichotomy Logistic regression model for analysis, and the result showed that all indicators above were the independent risk factors of secondary cerebral hemorrhage after cerebral infarction intravenous thrombolysis.Conclusion:The current status of secondary cerebral hemorrhage after cerebral infarction intravenous thrombolysis is far from being optimistic, with certain risks, while mastering the high risk factors of cerebral hemorrhage conversion actively and identifying them early could help the key prevention and control, so as to reduce the rate of secondary cerebral hemorrhage after cerebral infarction intravenous thrombolysis, improve the thrombolysis quality and promote the patients'' early rehabilitation.