血压变化对急性缺血性脑卒中患者 rt-PA 溶栓后出血转化的影响。

IF 2.3 Q2 MEDICINE, GENERAL & INTERNAL SAGE Open Medicine Pub Date : 2024-09-29 eCollection Date: 2024-01-01 DOI:10.1177/20503121241283881
Sihan Liu, Jiadi Gao, Hanshu Zhao, Yuanqi Xu, Yubing Zhou, Yushuang Liu, Jinru Shen, Zhongling Zhang
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引用次数: 0

摘要

背景:由于不同研究的方法不一致,急性缺血性卒中患者重组组织浆细胞酶原激活剂溶栓后血压变化与出血转化之间的关系尚不确定。本研究旨在阐明入院后 24 小时收缩压极值与出血转化之间的关系,同时考虑出血转化发生在初始监测期之后的可能性:我们选取了 2020 年 1 月至 2022 年 12 月期间哈尔滨医科大学附属第一医院收治的缺血性脑卒中患者,这些患者在症状出现后 4.5 小时内接受了静脉注射重组组织浆细胞酶原激活剂治疗。我们分析了入院血压、入院后 24 h 重组组织纤溶酶原激活剂(平均值、最大值、最小值、极差、标准差和变异系数)、溶栓后即刻血压和溶栓后 1 h 血压与溶栓后 36 h 内发生出血转变之间的关系。在解释结果时还考虑了延迟出血转化的可能性:结果:在138名患者中,39.1%发生了溶栓后出血转化。多变量分析显示,出血转化与冠状动脉疾病、脑白质疏松、大面积脑梗死、随机血糖水平升高以及入院时 24 小时收缩压极值显著相关。具体来说,24 小时收缩压极值与出血转化呈显著正相关(OR = 1.042; 95% CI: 1.000-1.086, p 结论:这些发现强调了建立健全的连续血压监测方案和针对个体风险特征的干预策略的重要性。鉴于出血转化可能发生在最初的 36 小时之后,临床医生应保持对延迟出血转化的警惕,尤其是重组组织纤溶酶原激活剂较高的患者。严格控制血压,尤其是尽量减少收缩压的极端变化,对于确保溶栓患者的安全至关重要。
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Impact of blood pressure variability on hemorrhagic transformation post-rt-PA thrombolysis in patients with acute ischemic stroke.

Background: The relationship between blood pressure variability and hemorrhagic transformation after recombinant tissue plasminogen activator thrombolysis in patients with acute ischemic stroke is uncertain due to inconsistent methodologies across studies. This study aimed to elucidate the association between 24-h systolic blood pressure extremes post-admission and hemorrhagic transformation while considering the possibility of hemorrhagic transformation occurring beyond the initial monitoring period.

Methods: We enrolled patients admitted to The First Affiliated Hospital of Harbin Medical University for ischemic stroke who were treated with intravenous recombinant tissue plasminogen activator within 4.5 h of symptom onset between January 2020 and December 2022. We analyzed the relationships among admission blood pressure, 24-h post-admission recombinant tissue plasminogen activator (mean, maximum, minimum, extreme difference, standard deviation, and coefficient of variation), immediate and 1-h post-thrombolysis blood pressure, and hemorrhagic transformation occurrence within 36 h post-thrombolysis. The potential for delayed hemorrhagic transformation was also considered during the interpretation of the results.

Results: Among the 138 patients, 39.1% experienced post-thrombolytic hemorrhagic transformation. Multivariate analysis revealed that hemorrhagic transformation was significantly associated with coronary artery disease, cerebral leukoaraiosis, large cerebral infarction, elevated random glucose levels, and 24-h systolic blood pressure extremes at admission. Specifically, 24-h systolic blood pressure extremes showed a significant positive correlation with hemorrhagic transformation (OR = 1. 042; 95% CI: 1.000-1.086, p < 0.05).

Conclusion: These findings underscore the importance of establishing robust protocols for continuous blood pressure monitoring and intervention strategies tailored to individual risk profiles. Given that hemorrhagic transformation can occur beyond the initial 36 h, clinicians should maintain vigilance for delayed hemorrhagic transformation, particularly in patients with high recombinant tissue plasminogen activator. Strict control of blood pressure, especially minimizing extremes in systolic blood pressure, is essential to ensure the safety of patients undergoing thrombolysis.

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来源期刊
SAGE Open Medicine
SAGE Open Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
3.50
自引率
4.30%
发文量
289
审稿时长
12 weeks
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