Development of predictive model for post-thrombolysis hemorrhage in patients with acute ischemic stroke

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

Abstract

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

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

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.

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.

Figures/Tables 3

References 24

[1]	Writing Group Members, Mozaffarian D, Benjamin EJ , et al. Heart disease and stroke statistics-2016 update:a report from the American heart association[J]. Circulation, 2016,133(4):e38-e360.
[2]	王陇德, 刘建民, 杨弋 , 等. 我国脑卒中防治仍面临巨大挑战:《中国脑卒中防治报告2018》概要[J]. 中国循环杂志, 2019,34(2):105-119.
[3]	Hacke W, Kaste M, Fieschi C , et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke(ECASS II). Second European-Australasian acute stroke study investigators[J]. Lancet, 1998,352(9136):1245-1251.
[4]	Derex L, Hermier M, Adeleine P , et al. Clinical and imaging predictors of intracerebral haemorrhage in stroke patients treated with intravenous tissue plasminogen activator[J]. J Neurol Neurosurg Psychiatry, 2005,76(1):70-75.
[5]	Dietrich WD, Alonso O, Busto R . Moderate hyperglycemia worsens acute blood-brain barrier injury after forebrain ischemia in rats[J]. Stroke, 1993,24(1):111-116.
[6]	Demchuk AM, Morgenstern LB, Krieger DW , et al. Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke[J]. Stroke, 1999,30(1):34-39.
[7]	Romano JG, Smith EE, Liang L , et al. Outcomes in mild acute ischemic stroke treated with intravenous thrombolysis:a retrospective analysis of the get with the guidelines-stroke registry[J]. JAMA Neurol, 2015,72(4):423-431.
[8]	陈念, 王平平, 吴杨 , 等. 急性脑梗死r-tPA静脉溶栓所致颅内和非颅内出血事件研究[J]. 河北医药, 2013,35(14):2153-2154.
[9]	Demaerschalk BM, Kleindorfer DO, Adeoye OM , 等. 急性缺血性卒中静脉阿替普酶溶栓治疗的纳入和排除标准的科学依据美国心脏协会/美国卒中协会对医疗卫生专业人员发布的声明[J]. 国际脑血管病杂志, 2016,24(4):385-406.
[10]	王新, 王拥军, 刘峥 , 等. 四个脑卒中量表信度与效度的对比研究[J]. 中华物理医学与康复杂志, 1999,21(3):140-143.
[11]	张雅静, 张小兰, 马延爱 , 等. Barthel指数量表应用于急性脑卒中患者生活能力测量的信度研究[J]. 中国护理管理, 2007,7(5):30-32.
[12]	Seet RC, Rabinstein AA . Symptomatic intracranial hemorrhage following intravenous thrombolysis for acute ischemic stroke:a critical review of case definitions[J]. Cerebrovasc Dis, 2012,34(2):106-114.
[13]	Yaghi S, Willey JZ, Cucchiara B , et al. Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke:a scientific statement for healthcare professionals from the American heart association/American stroke association[J]. Stroke, 2017,48(12):e343-e361.
[14]	Waltimo T, Haapaniemi E, Surakka IL , et al. Post-thrombolytic blood pressure and symptomatic intracerebral hemorrhage[J]. Eur J Neurol, 2016,23(12):1757-1762.
[15]	Butcher K, Christensen S, Parsons M , et al. Postthrombolysis blood pressure elevation is associated with hemorrhagic transformation[J]. Stroke, 2010,41(1):72-77.
[16]	苏敏, 杨卫新, 王万华 , 等. 急性缺血性卒中重组组织型纤溶酶原激活剂静脉溶栓致出血性转化及其预后的危险因素分析[J]. 中华神经科杂志, 2011,44(11):754-758.
[17]	Sung SF, Chen SC, Lin HJ , et al. Comparison of risk-scoring systems in predicting symptomatic intracerebral hemorrhage after intravenous thrombolysis[J]. Stroke, 2013,44(6):1561-1566.
[18]	Strbian D, Michel P, Seiffge DJ , et al. Symptomatic intracranial hemorrhage after stroke thrombolysis:comparison of prediction scores[J]. Stroke, 2014,45(3):752-758.
[19]	Mazya M, Egido JA, Ford GA , et al. Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase:safe Implementation of Treatments in Stroke(SITS) symptomatic intracerebral hemorrhage risk score[J]. Stroke, 2012,43(6):1524-1531.
[20]	Menon BK, Saver JL, Prabhakaran S , et al. Risk score for intracranial hemorrhage in patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator[J]. Stroke, 2012,43(9):2293-2299.
[21]	Brownlee WJ Wu TY van Dijck SA , et al. Upper limb compartment syndrome:an unusual complication of stroke thrombolysis[J]. J Clin Neurosci, 2014,21(5):880-882.
[22]	Sutter R, Bruder E, Weissenburg M , et al. Thyroid hemorrhage causing airway obstruction after intravenous thrombolysis for acute ischemic stroke[J]. Neurocrit Care, 2013,19(3):381-384.
[23]	常红, 王晓娟 . 阿替普酶静脉溶栓治疗急性缺血性脑卒中出血并发症发生时间的观察[J]. 中华护理杂志, 2014,49(10):1191-1193.
[24]	Chang H, Wang XJ, Yang X , et al. Digestive and urologic hemorrhage after intravenous thrombolysis for acute ischemic stroke:data from a Chinese stroke center[J]. J Int Med Res, 2017,45(1):352-360.