[1]杜战锋 梁珂 谢军.缺血性脑卒中合并UIAs患者行rt-PA溶栓治疗的出血转化风险[J].卒中与神经疾病杂志,2019,26(05):522-525.[doi:10.3969/j.issn.1007-0478.2019.05.004]
　Du Zhanfeng,Liang Ke,Xie Jun..The risk of bleeding conversion in patients with ischemic brain stroke and UIAs undergoing rt-PA thrombolysis[J].Stroke and Nervous Diseases,2019,26(05):522-525.[doi:10.3969/j.issn.1007-0478.2019.05.004]
点击复制

缺血性脑卒中合并UIAs患者行rt-PA溶栓治疗的出血转化风险()
分享到：

《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第26卷
期数:
2019年05期
页码:
522-525
栏目:
论 著
出版日期:
2019-10-20

文章信息/Info

Title:
The risk of bleeding conversion in patients with ischemic brain stroke and UIAs undergoing rt-PA thrombolysis
文章编号:
1007-0478(2019)05-0522-04
作者:
杜战锋 梁珂 谢军
727000 陕西省铜川市人民医院神经外科
Author(s):
Du Zhanfeng;  Liang Ke;  Xie Jun.
Department of Neurosurgery, the People's Hospital of Tongchuan, Tongchuan Shaanxi 727000
关键词:
缺血性脑卒中 颅内动脉瘤 溶栓治疗 安全性
Keywords:
Ischemic brain stroke Intracranial aneurysm Thrombolytic therapy Safety
分类号:
R743.3
DOI:
10.3969/j.issn.1007-0478.2019.05.004
文献标志码:
A
摘要:
目的 探讨rt-PA溶栓对缺血性脑卒中合并颅内未破裂动脉瘤(UIAs)患者的临床治疗安全性。方法 将2015年6月-2018年5月收治行rt-PA溶栓治疗的84例缺血性脑卒中患者作为观察对象,溶栓前常规CT平扫以排除脑出血,溶栓后行DSA、CTA、MRI等颅脑检查,了解患者是否合并UIAs,并将患者分为未合并UIAs(对照组)与合并UIAs(观察组),并分析UIAs对溶栓的预后、不良事件的影响。结果 观察组患者中38例瘤体直径2.0～6.0 mm,1例直径8.5 mm,平均直径(4.2±1.18)mm。2组溶栓后LDL、同型半胱氨酸表达水平比较有显著差异(P<0.05); 观察组溶栓后出血转化发生率11.11%(5/45),溶栓7 d后NIHSS评分(5.1±3.82)分,与对照组溶栓后出血转化发生率7.69%(3/39)及溶栓7 d后NIHSS评分(4.7±2.36)比较无明显差异(P>0.05)。对照组临床有效率、预后良好率分别是42.22%(19/45)、82.22%(37/45),与观察组38.46%(15/39)、79.49%(31/39)比较无明显差异(P>0.05)。结论 缺血性脑卒中患者合并直径≤6.0 mm的颅内未破裂动脉瘤,行rt-PA溶栓治疗不会增加溶栓后出血转化风险,是比较安全的治疗方案。
Abstract:
ObjectiveTo analyze the safety of rt-PA thrombolysis in the treatment of ischemic brain stroke with intracranial unruptured aneurysms(UIAs).Methods 84 cases of ischemic brain stroke patients with rt-PA thrombolysis treatment in our hospital from June 2015 to May 2015 were choosed as research object,the routine CT scan was taken to rule out bleeding before thrombolysis.After thrombolysis,DSA,CTA,MRI and other brain examinations were performed to understand whether the patients were complicated with UIAs,and to analyze the impact of UIAs on the prognosis and adverse events of thrombolysis.Results According to the imaging examination after thrombolysis,the ischemic brain stroke patients were divided into non-aneurysm(control group)and intracranial unruptured aneurysms(observation group).Among the patients of observation group,38 of them had a diameter of 2.0～6.0 mm,1 had a diameter of 8.5 mm,and the average diameter was(4.2±1.18)mm.T test and chi square test found that,after thrombolysis,the expression levels of LDL and homocysteine were different between the two groups (P<0.05).The incidence of hemorrhagic transformation after thrombolysis in the control group was 11.11%(5/45),and the NIHSS score(5.1±3.82)on 7thd after thrombolysis was not significantly different from that of the control group [7.69%(3/39)and(4.7±2.36)](P>0.05).The clinical efficiency and favorable prognosis rate of the control group were 42.22%(19/45)and 82.22%(37/45)respectively,the observation group was 38.46%(15/39)and 79.49%(31/39)respectively,and there was no statistical significance(P>0.05).Conclusion The rt- PA thrombolysis of ischemic brain stroke patients with ≤6.0 mm diameter intracranial unruptured aneurysms would not increase the risk of hemorrhagic transformation after thrombolysis.it was a relatively safe treatment program.

参考文献/References:

[1] 虞德明,白亚强,刘文晶.血管内介入在颅内动脉瘤治疗的临床疗效观察[J].重庆医学,2016,45(18):2552-2554. [2] 邹文辉.CT与MR血管造影诊断颅内动脉瘤的价值比较[J].现代中西医结合杂志,2016,25(12):1348-1350. [3] Singh K,Mowla A,Mehla S,et al.Safety of intravenous thrombolysis for acute ischemic stroke in patients with preexisting intracranial neoplasms:a case series[J].International Journal of Stroke,2015,10(3):E29-E30. [4] 陈胡萍,曾宪容,高椿,等.无症状颅内动脉瘤的急性脑梗死患者静脉溶栓治疗安全性的系统评价[J].中华神经科杂志,2014,47(9):643-647. [5] 耿玉荣,柳英杰,张云霞,等.伴未破裂颅内动脉瘤的急性脑梗死患者静脉溶栓治疗安全性评价[J].中国全科医学,2017,20(1):56-61. [6] 夏鹏飞,王伟,高旭婷,等.颅内未破裂动脉瘤介入术后脑缺血性损伤的危险因素分析[J].重庆医科大学学报,2018,2(2):1-4. [7] Tsivgoulis G,Zand R,Katsanos AH,et al.Risk of symptomatic intracerebral hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke and high cerebral microbleed burden:a meta-analysis[J].JAMA Neurol,2016,73(6):675-683. [8] 李雨晴,张佩兰.重组组织型纤溶酶原激活剂静脉溶栓治疗觉醒型卒中患者的安全性和有效性[J].实用医学杂志,2016,32(22):3765-3768. [9] 姚麟,连晓鹏,秦冰.急性缺血性脑卒中rt-PA静脉溶栓标准化诊疗流程实施效果分析[J].新医学,2015,46(10):702-705. [10] Tsivgoulis G,Safouris A,Alexandrov AV.Safety of intravenous thrombolysis for acute ischemic stroke in specific conditions[J].Expert Opin Drug Saf,2015,14(6):845-864. [11] 陆云南,华烨,冯志强,等.依达拉奉联合他汀类药物对缺血性脑卒中患者血清同型半胱氨酸,C反应蛋白,血脂水平的影响[J].实用临床医药杂志,2017,21(19):27-30. [12] 黄如月,罗敏,黄双双,等.合并颅内动脉瘤的急性脑梗死静脉溶栓治疗四例报道及文献复习[J].中华神经医学杂志,2017,16(2):183-185. [13] 张玉显,张佩兰.合并脑微出血急性缺血性脑卒中患者静脉溶栓治疗的风险评估及安全性研究[J].中风与神经疾病杂志,2018,4(4):152-154. [14] Go AS,Mozaffarian D,Roger VL,et al.Executive summary:heart disease and stroke statistics--2014 update:a report from the American Heart Association[J].Circulation,2014,129(3):399-410. [15] 张文波.rt-PA静脉溶栓治疗急性缺血性脑卒中的血压变化及对预后的影响[J].脑与神经疾病杂志,2017,25(6):358-361.

相似文献/References:

[1]乔薇薇 王洁 吕红叶 温昌明 陈笛 李祥欣.缺血性脑卒中患者发生呼吸睡眠紊乱的影响因素[J].卒中与神经疾病杂志,2020,27(02):221.[doi:10.3969/j.issn.1007-0478.2020.02.018]

备注/Memo

备注/Memo:
(2019-02-11收稿)
更新日期/Last Update: 2019-10-20