| Objective: intravenous thrombolysis is the preferred method in acute cerebral infarction,and the most serious complication is hemorrhagic transformation(HT).According to the location relationship between ischemic infarction and hemorrhage,it can be divided into the hemorrhage inside the infarct and the hemorrhage outside the infarct,and the hemorrhage outside the infarct is also called remote parenchymal hemorrhage,rPH.In recent years,with the deepening of medical research,it is found that the prognosis of rPH is worse and the mortality is higher.Studies have shown that such hemorrhage can lead to severe neurological damage and poor prognosis,but its pathogenesis and risk factors are still unclear.Therefore,the main purpose of this study was to investigate the incidence of remote parenchyma hemorrhage(rPH)after intravenous thrombolysis in acute cerebral infarction and Related risk factors affecting the occurrence of rPH,Prognosis and mortality of distant hemorrhage.Methods:Collected from January 2013 to July 31,2018,the first hospital affiliated to dalian medical university neurology acute cerebral infarction(within 4.5 h)to use the original activator recombinant tissue fibrinolytic enzyme(rt-PA)intravenous thrombolysis in patients with clinical data,the sifting bleeding after thrombolysis in patients,according to the presence of hematogenously hemorrhage were divided into 2 groups,remote parenchyma hemorrhage(rPH)group and non-remote parenchyma hemorrhage(NrPH).recorded Baseline data,National Institutes of Health Stroke Scale(NIHSS),infarct area,hemorrhage site,Symptomatic intracranial hemorrhage(sICH),90 dmRS,and mortality et al,and analyzed the differences in long-term efficacy and safety between the two groups.Results: 1.A total of 502 patients with intravenous thrombolysis were collected,with an average age of 67.0±11.0 years old,among which 66.3% were male.Among them,81(16.13%)patients showed hemorrhagic transformation,and 7 patients showed rPH,with an incidence of 1.4%.2.There was no significant difference in gender,age,smoking,drinking,diabetes,hypertension between the two groups(all P < 0.05),and there was significant difference in history of atrial fibrillation,NIHSS score,large area cerebral infarction,and bleeding site(all P < 0.05).Multivariate analysis showed that atrial fibrillation was the main risk factor for increased rPH risk(OR 21.641,95%CI 1.499-312.507,P=0.024).3.In the rPH group,the proportion of cerebral lobe hemorrhage was the highest,followed by cerebral stem and cerebellum hemorrhage,and the last was deep hemorrhage(57.14%vs14.29%vs42.86%).In the non-distant site hemorrhage group,the proportion of deep hemorrhage was the highest(50.0%).4.Further compared remote parenchyma hemorrhage with parenchymal hematoma(PH),also found in age,sex,smoking,drinking,past medical history of no statistical difference(P > 0.05),in atrial fibrillation,infarction area was statistically difference(P < 0.05),and further confirmed that atrial fibrillation is the main factors influencing the.5.The incidence of symptomatic intracranial hemorrhage(sICH)between the two groups was 42.9%vs33.3%,with no statistical difference(p > 0.05).There was no significant difference in mortality between the two groups(57.1%vs25%)(2=3.280,p=0.07).The proportion of poor prognosis at 3 months(85.7%vs79.8%)was not statistically significant(p=0.803).Conclusion: In this study,remote parenchyma hemorrhage was a rare complication after rt-pa thrombolysis.Atrial fibrillation is an important factor affecting the remoteness after rt-pa thrombolysis in acute cerebral infarction.Both distant hemorrhage and non-distant hemorrhage can aggravate the disease,and their safety and prognosis are similar.rPH is lobar hemorrhage.the occurrence of remote parenchyma hemorrhage after intravenous thrombolysis in acute cerebral infarction may be related to cerebral microhemorrhage. |
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