Study On Risk Factors Of Hemorrhagic Transformation After Intravenous Thrombolysis In Acute Cerebral Infarction

Objectives This study analyzed the demographic characteristics and clinical data of patients with acute cerebral infarction who received intravenous thrombolytic therapy in the Department of Neurology,and analyzed the incidence of hemorrhagic transformation,hemorrhagic transformation,and clinical conversion after intravenous thrombolysis in patients with acute cerebral infarction.The risk factors for hemorrhagic transformation and risk factors for death after hemorrhagic transformation were further screened out to identify people at high risk of hemorrhagic transformation prior to clinical thrombolytic therapy and to effectively prevent and control the occurrence of hemorrhagic transformation.To provide a theoretical basis for reducing mortality and disability.Methods Screening of patients with acute cerebral infarction who were hospitalized in the Department of Neurology of our hospital from January 2015 to January 2017 and included in the cases according to the inclusion criteria and exclusion criteria,reviewing demographic data,laboratory data,and clinical manifestations,imaging data,whether the hemorrhagic transformation and clinical outcomes.To analyze the incidence and outcome of hemorrhagic transformation after intravenous thrombolysis in patients with acute cerebral infarction.After intravenous thrombolysis,patients were divided into hemorrhagic and non-hemorrhagic transformations,further age(≤60 yrs;>60 yrs),systolic blood pressure(≤150 mm Hg;>150 mm Hg),previous stroke,and hypertension Whether or not diabetes,atrial fibrillation,long-term use of anticoagulant antithrombotic drugs,onset to thrombolysis time(≤3h;>3h),low density,infarct size(small,large,lacunar),LDL(≤3.12 Mmol/L;> 3.12 mmol/L),FPG(≥7.0(mmol/L);<7.0(mmol/L),NIHSS score(≤12;>12),included in the logistics review,first using single factor logistics Regression,with P<0.15 as the criteria for inclusion of multivariate analysis,and then the possible risk factors selected were included in multivariate logistic regression to analyze risk factors for hemorrhagic transformation after thrombolytic therapy.Similarly,intravenous thrombolytic therapy was used.The patients were divided into hemorrhagic transformation death and hemorrhagic transformation non-death,and the risk factors of hemorrhagic transformation death after intravenous thrombolytic therapy were analyzed by univariate and multivariate logistic regression using the same method.Results 1.A total of 130 patients were included in the study.There were 91 males and 39 females with an average age of 61.5 years.The average NIHSS score was 13.3.The average time from onset to thrombolysis was 3.73 hours.In patients with acute cerebral infarction,85 patients(65.38%)had no hemorrhage after intravenous thrombolysis,45(34.62%)had hemorrhagic transformation,and 19(14.62%)had symptomatic cerebral hemorrhage(SICH).Patients with symptomatic intracerebral hemorrhage were found to have worsening clinical symptoms within 24 hours after intravenous thrombolytic therapy,with an increase of ≥ 4 points relative to baseline/lowest NIHSS.Hemorrhagic transformation was diagnosed by head CT examination.The mortality in the hemorrhagic transformation group was 24.44%,and the mortality rate in the non-hemorrhagic transformation group was 4.71%.The statistical analysis showed that the mortality rate in the hemorrhagic transformation group was higher than that in the non-hemorrhagic transformation group(P<0.05).2.In the analysis of risk factors for hemorrhagic transformation after thrombolytic therapy,univariate analysis showed that previous cerebral infarction,hypertension,diabetes,atrial fibrillation,onset to thrombolysis time,low density,infarct size,and NIHSS score were possible.Influencing factors,multivariate analysis showed that the incidence of atrial fibrillation(OR:0.056,95%CI:0.009-0.342,P<0.002)to thrombolysis time(OR: 0.088,95% CI: 0.024-0.318,P<0.001 Whether it was low density(OR: 14.887,95%CI: 2.758-80.361,P<0.002),infarct size(OR: 3.122,95% CI: 1.551-6.283,P<0.001),NIHSS score(OR: 0.230,95%CI: 0.086-0.614,P<0.003)was associated with hemorrhagic transformation after thrombolytic therapy.3.In the analysis of risk factors for hemorrhagic transformation after intravenous thrombolysis,single factor showed systolic blood pressure,previous cerebral infarction,hypertension,diabetes,atrial fibrillation,low density,and infarct size as possible risk factors.Further multi-factor analysis showed that the above factors did not reach statistically significant differences.Conclutions The incidence of hemorrhagic transformation after intravenous thrombolysis in patients with acute cerebral infarction was high,reaching 34.62%,and the incidence of symptomatic cerebral hemorrhage(SICH)was 14.62%.After intravenous thrombolysis in patients with acute cerebral infarction,hemorrhagic transformation occurred in patients with higher mortality than those without hemorrhagic transformation.Atrial fibrillation,onset of thrombolysis for more than 3 hours,low density on CT,large infarct size,and NIHSS score of more than 12 were risk factors for hemorrhagic transformation after thrombolytic therapy.