Chảy máu não có triệu chứng sau điều trị tiêu sợi huyết tĩnh mạch ở bệnh nhân nhồi máu não cấp=Symptomatic intracranial haemorrhage after intravenous alteplase in acute ischemic stroke

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Tác giả: Phương Vy Lê, Anh Tài Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.119-125

Bộ sưu tập: Metadata

ID: 242216

Thêm vào giỏ

Tìm các yếu tố nguy cơ CMNTC sau điều trị TSHTM ở bệnh nhân NMN nhập viện trong cửa số 4,5 giờ. Phương pháp: Phân tích dữ liệu bệnh nhân (BN) NMN được chăm sóc tại Bệnh viện Chợ Rẫy bằng phương pháp TSHTM trong giai đoạn từ tháng 10 đến tháng 12 năm 2023 để tìm các yếu tố liên quan đến biến chứng CMNTC. Biến chứng CMNTC được chẩn đoán theo phân loại Idelberg trong vòng 24 giờ sau điều trị TSHTM. Phân tích đa biến để tìm mô hình dự đoán biến chứng này khi điều trị TSHTM trong NMN cấp. Kết quả: 10 BN NMN cấp đến bệnh viện Chợ Rẫy trong cửa sổ thời gian 4,5 giờ, được điều trị tái thông bằng phương pháp TSHTM. Có 20 % trường hợp có biến chứng CMNTC và không liên quan đến kết cục xấu lúc ra viện (p=0,06). Các yếu tố liên quan đến biến chứng CMNTC sau điều trị tái thông bằng tiêu sợi huyết: điểm Glasgow lúc nhập viện (P=0,05), điểm Glasgow sau điều trị tái thông (P=0,05) và huyết áp trung bình trong 24 giờ đầu sau điều trị tái thông ở mức 140- 159mmHg. Phân tích đa biến ghi nhận các yếu tố có thể dự đoán biến chứng trên gồm: huyết áp tâm thu lúc nhập viện, thời gian từ lúc nhập viện đến khi được điều trị tiêu sợi huyết, điểm NIHSS sau điều trị tái thông, huyết áp trung bình trong 24 giờ đầu sau điều trị tái thông ở mức 140- 159mmHg với diện tích dưới đường cong ROC lần lượt là 0,86, 0,79, 0,82 và 0,86. Kết luận: Độ nặng NMN đánh giá bằng thang điểm Glasgow, mức huyết áp trung bình trong 24 giờ đầu sau điều trị tái thông có liên quan biến chứng CMNTC. Các mức huyết áp lúc nhập viện và huyết áp trong khoảng 140- 159 mmHg trong 24 giờ đầu sau can thiệp có thể dự đoán biến chứng trên bên cạnh thời gian từ lúc nhập viện đến khi khởi đầu điều trị tiêu sợi huyết tĩnh mạch và độ nặng nhồi máu não sau tái thông đánh giá bằng thang điểm NIHSS.To find risk factors of sICH complication following IV rtpA in AIS patients presenting to hospital within a 4.5-hour time window. Method: We performed data analysis of AIS patients cared for at Cho Ray Hospital by using IV rtpA from October to December 2023 in order to find risk factors that were associated with sICH complications. sICH complications are diagnosed according to the idelberg classification within 24 hours of IV rtpA therapy. Multivariate analysis to find a model for predicting this complication. Results: Of the 10 patients admitted to Cho Ray hospital within a period of 4.5 hours and treated with IV rtpA, 20% of cases had complications of intracerebral haemorrhage that were symptomatic and not associated with poor outcomes at discharge (p=0.06). Risk factors associated with sICH complications after IV rtpA: Glasgow score at admission (P = 0.05), Glasgow score after revascularization (P=0.05), and mean systolic blood pressure (SBP) in the first 24 hours after revascularization treatment at level 140- 159mmHg. Multivariate analysis noted factors that can predict the above complication including: SBP at admission, time from admission to intravenous fibrinolysis, NIHSS score after revascularization treatment, mean SBP in the first 24 hours after revascularization treatment at 140-159mmHg with area under ROC curve of 0.86, 0.79, 0.82 and 0.86, respectively. Conclusion: The severity of AIS assessed by using the Glasgow scale, the mean SBP level in the first 24 hours after revascularization treatment is associated with complications of sICH. Levels of SBP at admission and mean SBP between 140-159 mmHg in the first 24 hours after intervention can predict this complication in addition to time from admission to initiation of IV rtpA and post-revascularization AIS severity assessed using the NIHSS score.

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