Size matters - Hemorrhage volume as an objective measure to define significant intracranial hemorrhage associated with thrombolysis
Size matters - Hemorrhage volume as an objective measure to define significant intracranial hemorrhage associated with thrombolysis
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DOI：
10.1161/strokeaha.106.472282
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发表时间：
2007-06-01
期刊：
影响因子：
8.3
通讯作者：
Yang, Ming
中科院分区：
文献类型：
--
作者：
Christoforidis, Gregory A.;Slivka, Andrew;Yang, Ming
背景和目的-本研究通过确定一个客观的阈值体积，预测临床恶化可归因于ICH.Methods -Prosthesis收集的临床和影像学信息，从103例连续的急性缺血性卒中患者接受动脉内溶栓治疗，定义了显著的溶栓相关颅内出血（ICH）。采用分层血肿体积与24 - 36小时和出院时美国国立卫生研究院卒中量表（NIHSS）评分变化之间的多重配对比较来确定显著差异。研究出血量和梗死体积与临床结局之间的关系。出血性转化（HT）、症状性出血和累及30%以上梗死的脑实质血肿的发生率与出血量进行比较。多元回归分析被用来确定出院NIHSS评分和出血量的变化之间的关系调整已知的预测临床outcomes.Results -多配对比较表明，出血大于25毫升（HV 25）有一个更明显的影响NIHSS评分出院时间比在24至36小时。27例（26.2%）患者患有HT，12例（11.7%）患者患有HV 25。在有症状的出血中，脑实质血肿累及超过30%的梗死，HV 25，HV 25似乎更能反映ICH的临床恶化。出血量增加梗死体积，但他们独立相关的变化NIHSS评分回归analysis.Conclusion -临床恶化从ICH和缺血性损伤更有效地区分在出院时。作者建议将溶栓相关的严重出血定义为出血量大于25 mL。
Background and Purpose - This study defines significant thrombolysis associated intracranial hemorrhage ( ICH) by identifying an objective threshold volume that predicts clinical deterioration attributable to ICH.Methods - Prospectively collected clinical and radiographic information, from 103 consecutive patients who underwent intraarterial thrombolysis for acute ischemic stroke, was reviewed. Multiple paired comparisons between stratified hematoma volume and change in National Institutes of Health Stroke Scale ( NIHSS) score by 24 to 36 hours and by time of hospital discharge was used to identify significant differences. Associations between hemorrhage volume and infarct volume in relation to clinical outcomes were examined. Rates of hemorrhagic transformation ( HT), symptomatic hemorrhage, and parenchymal hematoma involving over 30% of the infarct were compared with hemorrhage volume. Multivariate regression analysis was used to determine the relationship between change in discharge NIHSS score and hemorrhage volume adjusting for known predictors of clinical outcomes.Results - Multiple paired comparisons indicate that hemorrhage greater than 25 mL ( HV25) had a more distinct impact on NIHSS score by time of hospital discharge than at 24 to 36 hours. Twenty- seven ( 26.2%) patients had HT and 12 ( 11.7%) had HV25. Among symptomatic hemorrhage, parenchymal hematoma involving over 30% of the infarct, and HV25, HV25 appeared more reflective of clinical deterioration from ICH. Hemorrhage volume increased with infarct volume but they were independently associated with change in NIHSS score on regression analysis.Conclusion - Clinical deterioration from ICH and ischemic injury are more effectively distinguished at time of hospital discharge. The authors propose to define significant hemorrhage associated with thrombolysis as hemorrhage volume greater than 25 mL.