Blood Pressure Management and Evolution of Thrombolysis-associated Intracerebral Hemorrhage in Acute Ischemic Stroke
Blood Pressure Management and Evolution of Thrombolysis-associated Intracerebral Hemorrhage in Acute Ischemic Stroke
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DOI：
10.1016/j.jstrokecerebrovasdis.2011.05.006
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发表时间：
2012-11-01
影响因子：
2.5
通讯作者：
Mehta, Bijal
中科院分区：
文献类型：
--
作者：
Mokin, Maxim;Kass-Hout, Tareq;Mehta, Bijal
背景：对溶栓引起出血的影像学特征的认识有限。影响早期血肿扩大的因素尚未阐明。研究方法：本回顾性研究纳入了因组织纤溶酶原激活剂（tPA）静脉（IV）溶栓治疗急性缺血性卒中而出现症状性脑出血（ICH）并进行了头部非造影剂计算机断层扫描（CT）扫描的患者。计算血肿体积。协方差分析用于评估基线血压（BP）对初始血肿体积和进一步增长的影响。结果如下：2005年1月1日至2009年12月31日期间，在我们机构接受静脉tPA治疗急性缺血性卒中的267例患者中，17例患者发生症状性ICH，并纳入最终分析。溶栓后基线收缩压水平与初始血肿体积呈正相关（r = 0.46; P = 0.03），但与舒张压无关（r = 0.07; P = 0.40）。当比较第一次和第二次CT扫描的结果时，平均血肿体积扩张显著增加（中位数9小时22分钟; 14.9 +/- 19.6 cm（3）至26.0 +/- 26.7 cm（3）; P = 0.04）。收缩压降低与血肿生长呈负相关（r = -0.67; P = 0.02），但与舒张压变化无相关性（r = -0.22; P = 0.28）。结论：一旦确诊，溶栓诱导的症状性ICH在早期体积显著扩大。收缩压可能在血肿扩大中起作用。
Background: There is limited knowledge on the radiographic features of thrombolysis-induced hemorrhage. The factors that influence early hematoma expansion have not been elucidated. Methods: Patients presenting with a symptomatic intracerebral hemorrhage (ICH) as a result of intravenous (IV) thrombolysis with tissue plasminogen activator (tPA) for acute ischemic stroke and had noncontrast computed tomographic (CT) scans of the head were included in this retrospective study. Calculation of hematoma volumes was obtained. Analysis of covariance was used to evaluate for the effect of baseline blood pressure (BP) on initial hematoma volume and further growth. Results: Of 267 patients who were treated with intravenous tPA for acute ischemic stroke at our facility between January 1, 2005 and December 31, 2009, 17 patients developed symptomatic ICH and were included in the final analysis. There was a positive correlation between baseline level of systolic BP after thrombolysis and initial hematoma volume (r = 0.46; P = .03) but not for the diastolic BP (r = 0.07; P = .40). There was a significant increase in mean hematoma volume expansion when comparing results between the first and second CT scans (median 9 hours, 22 minutes; 14.9 +/- 19.6 cm(3) to 26.0 +/- 26.7 cm(3); P = .04). There was also a negative association between the reduction of systolic BP and hematoma growth (r = -0.67; P = .02), but no correlation with change in diastolic BP (r = -0.22; P = .28). Conclusions: Once diagnosed, thrombolysis-induced symptomatic ICH undergoes significant early expansion in size. Systolic BP may play a role in hematoma expansion.