急性缺血性脑卒中患者静脉溶栓后出血预警模型的构建

doi:10.3761/j.issn.0254-1769.2019.11.010.

摘要/Abstract

摘要：

目的构建急性缺血性脑卒中患者静脉溶栓后的出血预警模型。方法 2014年1月—2018年12月,选取某三级甲等医院高级卒中中心的急性缺血性脑卒中静脉溶栓后患者,收集患者的一般资料、出血相关指标、血液学检查结果等,通过二分类Logistic回归模型分析相关数据。结果纳入的924例急性缺血性脑卒中患者中,溶栓治疗后36 h内未出血者566例（未出血组）,出血者358例（出血组）,两组住院天数的比较,差异有统计学意义（Z=-2.596,P=0.009）。年龄、溶栓前收缩压、溶栓前使用抗栓药物、美国国立卫生研究院卒中量表评分是并发出血的危险因素,急性缺血性脑卒中患者静脉溶栓后出血预警模型ROC曲线下面积为0.682,95%CI为（0.571,0.793）,P<0.001。结论急性缺血性脑卒中患者静脉溶栓后外周系统出血的发生率较高,高龄、溶栓前高收缩压、有跌倒史等急性缺血性脑卒中患者,发生静脉溶栓后出血的风险较大,提示护士在临床工作中应重视出血并发症的预警与防治,出血预警模型可为出血并发症的护理观察及防治提供依据。

关键词: 急性缺血性脑卒中, 静脉溶栓, 出血, 并发症, 预警模型, 护理

Abstract:

Objective To establish a predictive model for post-thrombolysis hemorrhage in patients with acute ischemic stroke.Methods From January 2014 to December 2018,acute ischemic stroke patients who received rt-PA intravenously were recruited from an advanced stroke center at a tertiary hospital. General information,indicators related to hemorrhage,and blood test results were collected and analyzed using binary Logistic regression model.Results Among 924 recruited patients with acute ischemic stroke,566 had no bleeding complications within 36 hours after intravenous thrombolytic therapy（no bleeding group）,and 358 had bleeding symptoms（bleeding group）. The difference in hospitalization days between two groups was statistically significant（Z=-2.596,P=0.009）. Age,pre-thrombosis systolic pressure,history of falls,history of taking antithrombotic drugs,NIHSS score and DNT time were risk factors for hemorrhage. Based on the results,the predictive model was established and tested.Conclusion The incidence of peripheral bleeding after intravenous thrombolysis is higher,prognosis for patients with severe hemorrhage is poor. Attention should be paid to alert,prevention and treatment of hemorrhage. The predictive model is useful for providing reference for nursing observation,prevention and treatment of hemorrhage.

Key words: Acute Ischemic Stroke, Intravenous Thrombolysis, Hemorrhage, Complications, Predictive Model, Nursing Care

常红, 赵洁, 王晓娟, 张佳佳, 姚辉, 曹闻亚, 范凯婷, 马青峰. 急性缺血性脑卒中患者静脉溶栓后出血预警模型的构建[J]. 中华护理杂志, 2019, 54(11): 1648-1652.

CHANG Hong, ZHAO Jie, WANG Xiaojuan, ZHANG Jiajia, YAO Hui, CAO Wenya, FAN Kaiting, MA Qingfeng. Development of predictive model for post-thrombolysis hemorrhage in patients with acute ischemic stroke[J]. Chinese Journal of Nursing, 2019, 54(11): 1648-1652.

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