脑缺血溶栓期间或之后的口咽血管性水肿

Orolingual Angioedema During or After Thrombolysis for Cerebral Ischemia.

作者信息

Myslimi Fjorda, Caparros François, Dequatre-Ponchelle Nelly, Moulin Solène, Gautier Sophie, Girardie Patrick, Cordonnier Charlotte, Bordet Régis, Leys Didier

机构信息

From the Departments of Neurology (F.M., F.C., N.D.-P., S.M., C.C., D.L.), Intensive Care Medicine (P.G.), and Pharmacology (S.G., R.B.), University Lille 2, Lille, France; INSERM U 1171, Lille University Hospital (S.M., S.G., C.C., R.B., D.L.), Lille, France; and University of Medicine of Tirana, Tirana, Albania (F.M.).

出版信息

Stroke. 2016 Jul;47(7):1825-30. doi: 10.1161/STROKEAHA.116.013334. Epub 2016 May 19.

DOI:10.1161/STROKEAHA.116.013334

PMID:27197851

Abstract

BACKGROUND AND PURPOSE

Orolingual angioedema (OLAE) is a life-threatening complication of intravenous thrombolysis. Our objective was to compare outcomes of patients with and without OLAE.

METHODS

We prospectively included consecutive patients who received intravenous thrombolysis for cerebral ischemia at Lille University Hospital. We examined tongue and lips every 15 minutes during thrombolysis and ≤30 minutes after. We evaluated the 3-month outcome with the modified Rankin scale (mRS) and compared outcomes of patients with and without OLAE.

RESULTS

Of 923 consecutive patients, 20 (2.2%) developed OLAE. None of them needed oro-tracheal intubation. They were more likely to be under angiotensin-converting enzyme inhibitors (adjusted odds ratio [adjOR], 3.9; 95% confidence interval [CI], 1.6-9.7; P=0.005) to have total insular infarcts (OR, 5.0; 95% CI, 1.5-16.5; P=0.004) and tended to develop more symptomatic intracerebral hemorrhages. Results concerning angiotensin-converting enzyme inhibitors were not modified after adjustment for propensity scores (OR, 4.4; 95% CI, 1.6-11.9; P=0.004) or matched analysis based on propensity scores (OR, 3.4; 95% CI, 1.3-8.1; P=0.010). Patients with OLAE did not significantly differ at 3 months for the proportion of patients with mRS score of 0 to 1 (adjOR, 0.9; 95% CI, 0.3-2.1), mRS score of 0 to 2 (adjOR, 0.8; 95% CI, 0.1-1.8), and death (adjOR, 1.1; 95% CI, 0.3-3.8).

CONCLUSIONS

OLAE occurs in 1 of 50 patients who receive intravenous thrombolysis, 1 of 10 in case of total insular infarct, and 1 of 6 if they are under angiotensin-converting enzyme inhibitors. Their long-term outcome does not differ from that of other patients.

摘要

背景与目的

口咽血管性水肿（OLAE）是静脉溶栓治疗的一种危及生命的并发症。我们的目的是比较发生和未发生OLAE患者的结局。

方法

我们前瞻性纳入了在里尔大学医院接受脑缺血静脉溶栓治疗的连续患者。在溶栓期间每15分钟检查一次舌头和嘴唇，溶栓后≤30分钟内也进行检查。我们用改良Rankin量表（mRS）评估3个月时的结局，并比较发生和未发生OLAE患者的结局。

结果

在923例连续患者中，20例（2.2%）发生了OLAE。他们均无需进行气管插管。他们更有可能正在服用血管紧张素转换酶抑制剂（校正比值比[adjOR]，3.9；95%置信区间[CI]，1.6 - 9.7；P = 0.005），发生岛叶完全梗死（OR，5.0；95% CI，1.5 - 16.5；P = 0.004），并且更倾向于发生更多有症状的脑出血。在对倾向得分进行校正后（OR，4.4；95% CI，1.6 - 11.9；P = 0.004）或基于倾向得分进行匹配分析后（OR，3.4；95% CI，1.3 - 8.1；P = 0.010），关于血管紧张素转换酶抑制剂的结果没有改变。发生OLAE的患者在3个月时mRS评分为0至1的患者比例（adjOR，0.9；95% CI，0.3 - 2.1）、mRS评分为0至2的患者比例（adjOR，0.8；95% CI，0.1 - 1.8）以及死亡比例（adjOR，1.1；95% CI，0.3 - 3.8）与其他患者相比无显著差异。