rt-PA溶栓治疗急性缺血性卒中65例临床分析

发布时间：2018-06-05 02:42

本文选题：脑出血 + 危险因素　；参考：《重庆医科大学》2013年硕士论文

【摘要】：目的：分析rt-PA溶栓治疗急性缺血性卒中后脑出血的危险因素、发病率、临床症状、脑出血时间和CT分型，探讨脑出血的24小时神经功能变化及3个月临床预后。方法:回顾性收集了65例在发病后4.5h内接受rt-PA静脉或动脉溶栓治疗的急性缺血性卒中患者，溶栓24小时后常规复查头颅CT平扫，住院期间一旦发现病情恶化立即复查，观察溶栓后脑出血分型、时间分布、临床症状，并对患者基线特征、危险因素、实验室检查、临床评估及临床预后等进行分析。结果: 1.65例患者中，溶栓后脑出血9例（13.8%）。其中，症状性脑出血5例（7.7%），非症状性脑出血4例（6.1%）；HI-1型2例（3.1%），HI-2型2例（3.1%），PH-2型5例（7.7%），无PH-1型。 2.溶栓后脑出血的临床表现主要为头痛、肌力下降、意识下降、恶心呕吐、失语加重等，本组病例PH-2型出血（5例）主要发生在溶栓后0-12h内，，HI型（4例）出血主要发生在12-36h内。 3.与非脑出血组相比，HI型出血不影响24小时神经功能改变及3个月功能恢复；PH-2型显著增加24小时神经功能改变、3个月残疾和死亡。 4.多因素分析显示脑出血与高血糖（OR=2.214，95%CI1.219-4.018，P=0.009）、低血小板计数（OR=0.887，95%CI0.812-0.969，P=0.008）相关。结论： 1.溶栓后脑出血的发生率为13.8%，症状性脑出血发病率为7.7%，无症状性脑出血为6.1%。 2.脑出血的发生时间多在溶栓后24h内，3-4.5h溶栓的患者较3h内溶栓者容易出血。 3.脑出血的危险因素是低血小板计数与高血糖。
[Abstract]:Objective: to analyze the risk factors, incidence, clinical symptoms, time of cerebral hemorrhage and CT classification of cerebral hemorrhage after acute ischemic stroke treated with rt-PA thrombolytic therapy. Methods: 65 patients with acute ischemic stroke who received intravenous or arterial thrombolytic therapy with rt-PA within 4.5 hours after onset were retrospectively collected. Routine CT scans were performed 24 hours after thrombolysis. The types, time distribution, clinical symptoms, baseline characteristics, risk factors, laboratory examination, clinical evaluation and clinical prognosis of patients with intracerebral hemorrhage after thrombolysis were observed. Results: 1. Among 65 patients, 9 cases had cerebral hemorrhage after thrombolysis. There were 5 cases of symptomatic intracerebral hemorrhage and 4 cases of non-symptomatic intracerebral hemorrhage. There were 2 cases of HI-1 type and 2 cases of HI-2 type. There were 5 cases with PH-2 type and 5 cases with PH-2 type. There was no PH-1 type. 2. The main clinical manifestations of intracerebral hemorrhage after thrombolysis were headache, decreased muscle strength, decreased consciousness, nausea and vomiting, aggravation of aphasia, etc. In this group, PH-2 type hemorrhage occurred mainly in 4 cases within 0-12 hours after thrombolysis) and hemorrhage occurred mainly within 12-36 hours. 3. Compared with the non-cerebral hemorrhage group, HI type hemorrhage did not affect the 24 hour neurological function change and the 3 month recovery of PH-2 type significantly increased the 24 hour nerve function change, 3 months disability and death. 4. Multivariate analysis showed that intracerebral hemorrhage was associated with hyperglycemia (OR 2.214V 95 CI 1.219-4.018) and low platelet count (OR 0.88795 CI 0.812-0.969P 0.008). Conclusion: 1. The incidence of intracerebral hemorrhage after thrombolysis was 13.8%, that of symptomatic intracerebral hemorrhage was 7.7%, and that of asymptomatic intracerebral hemorrhage was 6.1%. 2. Patients with intracerebral hemorrhage within 24 hours after thrombolysis were more likely to bleed than those with thrombolytic therapy within 3 to 4.5 hours after thrombolysis. 3. The risk factors for intracerebral hemorrhage are low platelet count and hyperglycemia.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R743.3

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