Analysis Of Transformation Characteristics And Risk Factors Of Intracranial Hemorrhage After Intravenous Thrombosis In Acute Cerebral Infarction

Objective To analyze the probability and time of intracranial hemorrhage transformation in early stage(within 24h)after intravenous thrombolysis in patients with acute cerebral infarction,as well as the factors influencing the transformation of intracranial hemorrhage.Methods A total of 160 patients who were diagnosed with acute cerebral infarction and treated with intravenous thrombolysis(rt-PA)therapy in the general hospital of Ningxia Medical University and cardio cerebrovascular disease hospital from September 2018 to December 2020 were enrolled in this study,then 119 patients(male 76,female 22,average age 64 years)meeting the inclusion and exclusion criteria were selected as enrolled patients.All patients were reexamined for craniocerebral CT within 2 hours and 24 hours after thrombolysis,or when clinical symptoms were aggravated,and the incidence and time of early intracranial hemorrhage transformation within 24 hours after intravenous thrombolysis were calculated.According to the situation of intracranial hemorrhage,the subjects were divided into asymptomatic hemorrhage group(n = 21)and non-hemorrhage group(n = 97).The basic data,previous medical history and clinical data of the two groups were collected.Univariate analysis was used to get the preliminary influencing factors,and then the factors were included in binary logistic regression analysis to analysis the independent risk factors for early asymptomatic intracranial hemorrhage transformation within 24 hours after intravenous thrombolysis in acute cerebral infarction.Results 1.Among the 119 enrolled patients,22 cases had hemorrhagic transformation,accounting for 18.49% of the total,including 1 symptomatic hemorrhage,accounting for0.84% of the total;Asymptomatic hemorrhagic transformation occurred in 21 cases(17.60%).In terms of occurrence time,there were 8 cases of bleeding within 2 hours,accounting for6.7% of the total number,and 14 cases of bleeding within 2-24 hours,accounting for 11.76%of the total number.2.Univariate analysis showed that compared with the non bleeding group,the asymptomatic hemorrhagic transformation group had a higher age,a higher proportion of massive cerebral infarction,a higher ratio of absolute neutrophil count to absolute lymphocyte count,and a higher National Institute of Health Stroke Scale(NIHSS)score(P < 0.05).Serum albumin level was lower in the asymptomatic bleeding group(P < 0.05),which may be the influencing factor of bleeding transformation.3.Binary logistic regression analysis showed that large area cerebral infarction(OR=3.639,95%CI:1.130-11.718,P < 0.05),the ratio of absolutegranulocyte count to absolute lymphocyte count(OR=1.227,95% CI:1.030-1.462,P<0.05)and low serum albumin level(OR=0.861,95%CI:0.751-0.987,P<0.05)were independently associated with early asymptomatic bleeding transformation within 24 hours,and to be the risk factor.Conclusion1.Patients with acute cerebral infarction treated with rt-PA have hemorrhagic transformation within 24 hours,in which the asymptomatic hemorrhagic transformation accounted for the vast majority.2.Hemorrhagic transformation occurred 2h after intravenous thrombolysis with rt-PA in acute cerebral infarction.3.Large area of cerebral infarction,high ratio of the absolute neutrophil count to absolute lymphocyte count and low serum albumin level are independent risk factors for asymptomatic hemorrhagic transformation within 24 h after intravenous thrombolysis with rt-PA in acute cerebral infarction.