Tiên lượng chuyển dạng chảy máu trên bệnh nhân đột quỵ thiếu máu não cấp được điều trị tái thông=Prognosis of hemorrhagic transformation in acute ischemic stroke patients received revascularization treatment

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Huy Thắng Nguyễn, Lê Tuấn Anh Trương, Văn Sơn Trương

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.267-276

Bộ sưu tập: Metadata

ID: 477890

Thêm vào giỏ

Early prediction of hemorrhagic transformation (HT) in acute ischemic stroke patients undergoing revascularization therapy plays a part in treatment planning and providing necessary information for patients and their families. Therefore, our objective is to find factors that can predict HT. Subjects and methods: Prospective study including 220 acute ischemic stroke patients receiving revascularization treatment at 115 People's Hospital, Ho Chi Minh City. Subjects recruited upon admission were collected medical history, NIHSS score, HAT score, ASPECT score, clinical, paraclinical and brain imaging (CTscan/MRI). Subjects had NIHSS scores and imaging collected within 24± 6 hours after revascularization treatment. Univariate analysis and multivariate regression analysis were used to determine the role of variables on HT. Results: The mean age was 63 years old, 63.6% were male. There were 14 factors univariately associated with HT after 24 ± 6 hours of revascularization treatment in patients with acute ischemic stroke: HAT, NIHSS, ASPECT, age, smoking, hypertension, valvular heart disease, diabetes, heart rate, diastolic blood pressure, conscious disorders, cerebral artery hyperdense sign, blood glucose, red blood cells. Among them, cerebral artery hyperdense sign and especially HAT were two independent prognostic factors for HT through multivariate analysis. HAT had very strongly related to HT, HAT ≥ 2 were prognostic patients with HT after 24 ± 6 hours of recanalization treatment with a sensitivity of 94.3%
Specificity was 90.8%
The area under the curve was 96.5% and the positive predictive value was 91.1%. Conclusion: In patients with acute ischemic stroke treated with revascularization, cerebral artery hyperdense sign and HAT score at admission were the 2 strongest and independent prognostic factors of HT after 24 ± 6 hours since the patient received recanalization treatment.Tiên lượng sớm chuyển dạng chảy máu (CDCM) trên bệnh nhân đột quỵ thiếu máu não cấp (ĐQTMNC) được điều trị tái thông có một phần vai trò trong kế hoạch điều trị và cung cấp thông tin cần thiết cho bệnh nhân và gia đình bệnh nhân. Chính vì vậy, mục tiêu của chúng tôi là tìm các yếu tố có khả năng tiên lượng CDCM. Đối tượng và phương pháp: Nghiên cứu tiến cứu 220 bệnh nhân ĐQTMNC được điều trị tái thông tại Bệnh viện Nhân dân 115, TP.HCM. Đối tượng tuyển chọn lúc nhập viện được khai thác tiền sử, điểm NIHSS, điểm HAT, điểm ASPECT, lâm sàng, cận lâm sàng và hình ảnh học não (CTscan/MRI). Đối tượng được thu thập điểm NIHSS, hình ảnh học trong vòng 24 ± 6 giờ sau điều trị tái thông. Phân tích đơn biến và phân tích hồi quy đa biến được sử dụng để xác định vai trò của các biến đối với CDCM. Kết quả: Tuổi trung bình: 63
Nam giới: 63,6%. Có 14 yếu tố liên quan đơn biến với CDCM sau 24 ± 6 giờ điều trị tái thông ở bệnh nhân ĐQTMNC là: HAT, NIHSS, ASPECT, tuổi, hút thuốc lá, tăng huyết áp, bệnh van tim, đái tháo đường, nhịp tim, huyết áp tâm trương, rối loạn tri giác, tăng quang động mạch não (TQĐMN), mức glucose máu, hồng cầu. Trong đó, yếu tố TQĐMN và đặc biệt điểm HAT là 2 yếu tố tiên lượng độc lập CDCM qua phân tích đa biến. Điểm HAT có liên quan rất mạnh mẽ với CDCM (HAT ≥ 2 thì tiên lượng bệnh nhân có CDCM sau 24 ± 6 giờ được điều trị tái thông với độ nhạy là 94,3%
độ đặc hiệu là 90,8%
diện tích dưới đường cong là 96,5% và giá trị tiên đoán dương là 91,1%. Kết luận: Bệnh nhân ĐQTMNC được điều trị tái thông, TQĐMN và điểm HAT lúc nhập viện là 2 yếu tố tiên lượng độc lập và mạnh nhất của CDCM sau 24 ± 6 giờ kể từ khi bệnh nhân được điều trị tái thông.

1. Đọc trực tuyến

1. Đọc trực tuyến

Tạo bộ sưu tập với mã QR