發(fā)布時(shí)間：2018-06-05 02:42

  本文選題：腦出血 + 危險(xiǎn)因素　； 參考：《重慶醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的：分析rt-PA溶栓治療急性缺血性卒中后腦出血的危險(xiǎn)因素、發(fā)病率、臨床癥狀、腦出血時(shí)間和CT分型，探討腦出血的24小時(shí)神經(jīng)功能變化及3個(gè)月臨床預(yù)后。 方法:回顧性收集了65例在發(fā)病后4.5h內(nèi)接受rt-PA靜脈或動(dòng)脈溶栓治療的急性缺血性卒中患者，溶栓24小時(shí)后常規(guī)復(fù)查頭顱CT平掃，住院期間一旦發(fā)現(xiàn)病情惡化立即復(fù)查，觀察溶栓后腦出血分型、時(shí)間分布、臨床癥狀，并對(duì)患者基線特征、危險(xiǎn)因素、實(shí)驗(yàn)室檢查、臨床評(píng)估及臨床預(yù)后等進(jìn)行分析。 結(jié)果: 1.65例患者中，溶栓后腦出血9例（13.8%）。其中，癥狀性腦出血5例（7.7%），非癥狀性腦出血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%），無(wú)PH-1型。 2.溶栓后腦出血的臨床表現(xiàn)主要為頭痛、肌力下降、意識(shí)下降、惡心嘔吐、失語(yǔ)加重等，本組病例PH-2型出血（5例）主要發(fā)生在溶栓后0-12h內(nèi)，，HI型（4例）出血主要發(fā)生在12-36h內(nèi)。 3.與非腦出血組相比，HI型出血不影響24小時(shí)神經(jīng)功能改變及3個(gè)月功能恢復(fù)；PH-2型顯著增加24小時(shí)神經(jīng)功能改變、3個(gè)月殘疾和死亡。 4.多因素分析顯示腦出血與高血糖（OR=2.214，95%CI1.219-4.018，P=0.009）、低血小板計(jì)數(shù)（OR=0.887，95%CI0.812-0.969，P=0.008）相關(guān)。 結(jié)論： 1.溶栓后腦出血的發(fā)生率為13.8%，癥狀性腦出血發(fā)病率為7.7%，無(wú)癥狀性腦出血為6.1%。 2.腦出血的發(fā)生時(shí)間多在溶栓后24h內(nèi)，3-4.5h溶栓的患者較3h內(nèi)溶栓者容易出血。 3.腦出血的危險(xiǎn)因素是低血小板計(jì)數(shù)與高血糖。
[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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R743.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 中華醫(yī)學(xué)會(huì)神經(jīng)病學(xué)分會(huì)腦血管病學(xué)組急性缺血性腦卒中診治指南撰寫組;;中國(guó)急性缺血性腦卒中診治指南2010[J];中國(guó)全科醫(yī)學(xué);2011年35期

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