接受溶栓治疗的急性缺血性卒中患者院内死亡和有症状颅内出血的预测因素：保罗·科弗代尔急性卒中登记研究（2008 - 2012年）
Predictors of in-hospital death and symptomatic intracranial hemorrhage in patients with acute ischemic stroke treated with thrombolytic therapy: Paul Coverdell Acute Stroke Registry 2008-2012.
作者信息
Tong Xin, George Mary G, Yang Quanhe, Gillespie Cathleen
机构信息
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
出版信息
Int J Stroke. 2014 Aug;9(6):728-34. doi: 10.1111/ijs.12155. Epub 2013 Sep 12.
BACKGROUND
Limited studies exist on the outcome of thrombolytic therapy of acute ischemic stroke patients outside of clinical trials.
AIM
To assess the possible risk factors associated with in-hospital death and symptomatic intracerebral hemorrhage among patients who received intravenous tissue plasminogen activator.
METHODS
A total of 7193 patients with a clinical diagnosis of acute ischemic stroke and a documented National Institutes of Health Stroke Scale score were treated with intravenous tissue plasminogen activator within 4·5 hours of time last known to be well. Generalized estimating equations modeling was used to assess the associations of in-hospital death and symptomatic intracerebral hemorrhage with clinical characteristics.
RESULTS
Among 7193 patients treated with intravenous tissue plasminogen activator, 516 (7·2%) died during hospitalization. Factors associated with in-hospital death were older age, male gender, National Institutes of Health Stroke Scale score, history of myocardial infarction or coronary artery disease, and history of nonvalvular atrial fibrillation. Increasing age, higher National Institutes of Health Stroke Scale score, and history of dyslipidemia were associated with symptomatic intracerebral hemorrhage. There was no difference in the rates of in-hospital death or symptomatic intracerebral hemorrhage among patients treated with intravenous tissue plasminogen activator within three-hours of time last known to be well and those treated between three and 4·5 hours after this time.
CONCLUSIONS
In this study of acute ischemic stroke patients, older age, male gender, National Institutes of Health Stroke Scale score, history of myocardial infarction or coronary artery disease, and history of atrial fibrillation were associated with increased in-hospital death among patients receiving intravenous tissue plasminogen activator. Among patients treated with intravenous tissue plasminogen activator, in-hospital mortality and symptomatic intracerebral hemorrhage rates were similar between those treated within three-hours of time last known to be well and those treated between three and 4·5 hours after this time.
背景
关于急性缺血性脑卒中患者在临床试验之外进行溶栓治疗的结果，相关研究有限。
目的
评估接受静脉注射组织型纤溶酶原激活剂的患者中与院内死亡和症状性脑出血相关的可能危险因素。
方法
共有7193例临床诊断为急性缺血性脑卒中且有记录的美国国立卫生研究院卒中量表评分的患者，在最后一次已知状态良好后的4.5小时内接受了静脉注射组织型纤溶酶原激活剂治疗。采用广义估计方程模型评估院内死亡和症状性脑出血与临床特征之间的关联。
结果
在7193例接受静脉注射组织型纤溶酶原激活剂治疗的患者中，516例（7.2%）在住院期间死亡。与院内死亡相关的因素包括年龄较大、男性、美国国立卫生研究院卒中量表评分、心肌梗死或冠状动脉疾病史以及非瓣膜性心房颤动史。年龄增加、美国国立卫生研究院卒中量表评分较高和血脂异常史与症状性脑出血相关。在最后一次已知状态良好后的三小时内接受静脉注射组织型纤溶酶原激活剂治疗的患者与在此时间后三至4.5小时接受治疗的患者之间，院内死亡或症状性脑出血的发生率没有差异。
结论
在这项针对急性缺血性脑卒中患者的研究中，年龄较大、男性、美国国立卫生研究院卒中量表评分、心肌梗死或冠状动脉疾病史以及心房颤动史与接受静脉注射组织型纤溶酶原激活剂的患者院内死亡增加相关。在接受静脉注射组织型纤溶酶原激活剂治疗的患者中，最后一次已知状态良好后的三小时内接受治疗的患者与在此时间后三至4.5小时接受治疗的患者之间，院内死亡率和症状性脑出血发生率相似。
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