林亚楠,
郭岩^,
大连医科大学附属第一医院 神经内科，辽宁 大连 116011

详细信息 作者简介: 林亚楠（1992-），女，主治医师。E-mail：nanl0502@163.com


通讯作者: 郭 岩，主治医师。E-mail：guoyancc@sina.com 中图分类号: R743.3


摘要:目的探讨急性脑梗死静脉溶栓治疗后远隔部位出血（rPH）的发病率、危险因素以及预后。方法收集2016年1月1日至2020年4月30日就诊于大连医科大学附属第一医院神经内科接受rt-PA静脉溶栓治疗的512例急性脑梗死患者的临床资料，所有患者均采用标准剂量rt-PA静脉溶栓治疗，根据治疗后24小时内复查的头部影像学结果，分为未出血组（NrPH组，470例）与出血性转化组（HT组，42例），后者进一步分为出血性梗死组（HI组，n=21）、脑实质血肿组（PH组，n=9）与rPH组（n=12），比较rPH组与NrPH组患者的基线资料、基线NIHSS评分、实验室及影像学检查，分析导致rPH的危险因素；同时比较不同HT组的症状性颅内出血（sICH）发生率、90 d改良的Rankin量表（90 d-mRS）评定的预后良好比例及90 d死亡率，进一步分析梗死后合并rPH的预后。结果（1）rPH组和NrPH组在年龄、性别、吸烟史、饮酒史、糖尿病、高血压、基线NIHSS评分、大面积脑梗死等基线资料方面差异无统计学意义（均P＞0.05），而在房颤病史两组间的差异具有统计学意义（P＜0.05）；（2）HI组、PH组与rPH组sICH发生率分别为9.5%、66.7%、58.3%，90 d预后良好比例分别为61.9%、33.3%、16.7%，90 d死亡率分别为4.8%、44.4%、33.3%，差异均有统计学意义（均P＜0.05）。结论急性脑梗死患者接受静脉溶栓治疗后rPH的发生率为2.34%，房颤可能是急性脑梗死溶栓后rPH的危险因素，溶栓后合并rPH可导致患者预后不佳及死亡率增高。
关键词: 急性脑梗死/
静脉溶栓治疗/
出血性转化/
远隔部位出血


Abstract:ObjectiveTo investigate the incidence, related risk factors, prognosis and mortality of remote parenchymal hemorrhage (rPH) after intravenous thrombolysis in acute ischemic stroke. MethodsWe collected the data from 512 patients with acute ischemic stroke in the Department of Neurology at the First Affiliated Hospital of Dalian Medical University from 2016.1.1 to 2020.4.30. All patients received the treatment of intravenous recombinant tissue plasminogen activator (rt-PA). According to the presence of hemorrhage, we divided the hemorrhagic patients into remote parenchyma hemorrhage (rPH) group and non-remote parenchyma hemorrhage (NrPH) group. We analyzed the baseline data, the baseline of National Institutes of Health Stroke Scale (NIHSS), the laboratory and imagological examination to investigate the related risk factors of rPH. We compared the 90 d-mRS, and 90 d-mortality between each hemorrhagic transformation group in order to discuss the outcome of rPH. ResultsAmong the 512 patients, 42 patients (8.20%) had hemorrhagic transformation, and 12 patients (2.34%) showed rPH. There were no significant differences in gender, age, smoking, drinking, diabetes, hypertension, NIHSS score, large area cerebral infarction between the two groups (all P＞0.05), and there was significant difference in the history of atrial fibrillation (P＜0.05). Among HI, PH and rPH groups, there were significant differences in incidence rates of sICH (9.5% vs 66.7% vs 58.3%, P＜0.05), the proportion of poor prognosis at 3 months (61.9% vs 33.3% vs 16.7%, P＜0.05), and the mortality (4.8% vs 44.4% vs 33.3%, P＜0.05).ConclusionsBased on our study, the occurrence rate of remote parenchyma hemorrhage is rare. Atrial fibrillation might be an important factor affecting rPH after rt-PA thrombolysis in acute ischemic stroke. Both remote hemorrhage and non-remote hemorrhage can aggravate the disease.
Keywords:acute ischemic stroke/
intravenous thrombolysis/
hemorrhagic transformation/
remote parenchymal hemorrhage

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